Entering Term
Permanent Address
Date of Birth
Phone Number
Passport Number & Exp. Date
Marital Status
 Single, Never Married 
Spouse’s Name (if applicable)
College Attended, Years, GPA
Other Schools or Professional Qualifications
Please Describe Any Work Experience, Including Time At Each
 Occupational Skill 
Please Describe
Describe Your Salvation Experience
Have You Been Baptized?
Have You Experience w/ Gifts of the Spirit? If so, please describe
Do You Attend Church?
If Yes, Name of Church, Pastor, Phone #, and E-mail Address
If No, Do You Have a Spiritual Leader In Your Life?
 Involved in criminal activity 
 Struggling with suicidal thoughts 
 Sexually active 
 Addicted to pornography 
 Struggling with homosexual temptation 
 Addicted to alcohol 
 Involved in the occult 
 Taking medication 
 Allergic to certain things 
 Having ongoing medical issue(s) 
 Suffering from any other physical or mental disability (please describe below) 
 Struggling with any other issues (please describe below) 
Please Explain Answers Above
Do You Have Your Complete Course Fees?
If no, how are you planning to fund your support costs during the course?
 Partially by Donations 
 Completely by Donations 
 Work Prior to Arrival 
 Work During Course (tele-commuting) 
If Raising Funds, How Much Do You Currently Have Raised?
Do You Currently Have Outstanding Debt?
††Click yes if you have remaining school debt, credit card, mortgages, or other debt
If yes, please describe:
Have You Ever Participated In the Following:
 Short Term Missions (1 wk-1 mo) 
 Missions Trip (1-11 mos) 
 Long Term Missions (1 yr+) 
 The World Race 
 Other Missions Activity 
Describe any ministries/activities you have participated in.
Describe your current relationship with God.
Describe your calling, passions, & future goals & what impact this training will have on them
What are your expectations of G42? What would you like to see happen in your life during your time at G42?
Reference #1: Pastor/Spiritual Leader/WR Coach
††For each reference: 1) Please refrain from using immediate family. 2)Please include contact information, especially an e-mail address. 3) At least one of your three references needs to have known you for longer than five (5) years. 4) Please contact them to make sure that they are willing to participate, and let them know that we will be sending them a reference form that needs to be completed promptly.
Reference #2: Employer/Associate
Reference #3: Mentor/Teacher
How did you hear about us?
 From a G42 Leader 
 From a former graduate 
 Through the World Race 
 From my pastor 
 Web search/Web ad 
 Printed ad or brochure 
Referrer Name
††Please choose only one referrer. Also, let them know that you listed them, so that they can contact us about our incentive program.
What reason most influenced your decision to apply to G42?
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*
Please upload a recent photo of yourself.*
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