Application

Term Applying For:

Name

Permanent Address

Gender

Male
Female

Date of Birth

Phone

Passport Number & Exp. Date

Marital Status

Single, Never Married
Married
Separated
Divorced
Remarried
Widowed

Spouse’s Name (if applicable)

High School Attended, Years, GPA

College Attended, Years, GPA

Degree/Major

Other Schools or Professional Qualifications

Skills

Music
Language
Occupational Skill
Technology
Other

Please describe

Date of Salvation

Have You Been Baptized?

Yes
No

Have You Experience w/ Gifts of the Spirit? If
so, please describe

Do You Attend Church?

Yes
No

If Yes, Name of Church, Pastor, and Phone #

If No, Do You Have a Spiritual Leader In Your
Life?

Have You Ever Participated In the Following:

The World Race
Short Term Missions (1 wk-1 mo)
Missions Trip (1-11 mos)
African Vision Trip
Long Term Missions (1 yr+)
Other Adventures In Missions or G42 Activity

Describe any involvement in activities listed
above

Have You Ever or Are You Currently…

Been expelled or denied enrollment in a school or ministry?
Served time in a detention center or jail?
Been arrested or convicted of a crime?
Used tobacco products?
Used or abused alcohol?
Used or dealt illegal drugs?
Involved with gang-related activities?
Involved with a cult or the occult?
Sexually active (omit if married)?
Been pregnant or fathered a child?
Sexually or physically abused?
Involved in pornography?
Had suicidal thoughts or attempts?
Had homosexual feelings or activities?
—————————
Had diabetes or hypoglycemia?
Had seizures?
Had fainting spells?
Had an eating disorder?
Had breathing problems?
Had psychiatric care?
Taken depression medication?
Taken medication for behavior?

Please Explain

Do You Have Any Allergies, Medical Conditions,
or Physical Limitations?

Do You Have Your Complete School Fees?

Yes
No

Will You Be Raising Funds for Tuition?

Yes
No

If Raising Funds, How Much Do You Currently Have
Raised?

Describe any ministries/activities you have
participated in.

Describe your current relationship with Christ.

Describe your future goals & how this training
will contribute to them.

Reference #1: Pastor/Spiritual Leader (not
immediate family)

Reference #2: Employer/Associate/Teacher (not
immediate family)

Reference #3: Close Friend/Mentor

How did you hear about us?

From a Former Graduate
From a G42 or AIM Leader
Web Search
Facebook
Through the World Race
From my Pastor
From a brochure or printed ad

Agreement and Release

Check if you agree with the following statement: The information given here is accurate to the best of my knowledge. I authorize any references listed in this application to give G42 any information (including opinions) that they may have regarding my character, abilities or spiritual readiness for this program. I release all such references from any liability for furnishing either written or verbal information, opinions or evaluations to G42, provided they do so in good faith and without malice. I waive any right that I may have to inspect the information provided about me. Should my application be accepted, I agree to abide by the policies, guidelines and leadership of the program. (Your printed name below is your digital signature verifying this statement)

Digital Signature

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