Multiplying Laborers for the Urban Harvest

A p p e n d i x

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The Urban Ministry Institute Equipping Leadership for the Urban Church

Application for Admission

Personal Information

Full Name ______________________________________________

Home Address ______________________________________________

City, State, Zip ______________________________________________

Home phone ______________________________________________

Birth Date ______________________________________________

Sex

 Male

 Female

Marital status

 Single

 Married

E-mail ______________________________________________

Background Information

How long have you been a Christian? ______________________________________________

Name of the church you attend ______________________________________________

Denominational affiliation, if any ______________________________________________

Are you a member of this church? ______________________________________________

Who is the senior pastor of this church? ______________________________________________

Your spouse’s name ______________________________________________

Christian?

 Yes

 No

Children’s names and ages ______________________________________________

______________________________________________

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