DATE___________________________________

NAME___________________________________ PHONE#_______________________

ADDRESS________________________________ VA#__________________________

CITY___________________________________ STATE__________ ZIP__________

BIRTHDATE______________________________ S.S.#________________________

Check One:   MALE []      FEMALE []

Check One:   WHITE []     BLACK []    OTHER []___________________

1. Home Congregation_________________________________________________

2. How long have you been a member of the church?____________________

3. What activities have you engaged in where you worship? (Such as song leading, personal worker, class teacher, etc.)

_____________________________________________________________________

4. Give last grade completed in school.______________________________

5. Any special training or skills? Describe__________________________

6. What means of support will you have while attending school?

_____________________________________________________________________

7. Please check: Married [], Single [], Divorced [].
If you have been divorced, please explain cause:

_____________________________________________________________________

8. How many dependents do you have? _______ Their ages_______________

9. If married, how does your wife feel about you attending school?

_____________________________________________________________________

10. Have you ever been convicted of a crime? If so explain.

_____________________________________________________________________

_____________________________________________________________________

11. This course of study is real work. Are you determined to give it your best efforts and will follow through to completion?

_____________________________________________________________________

12. Are you willing to comply with the rules of behavior suggested by the teachers and the director of the school?_______

13. Will you be attending as a full time student of day classes or taking only night classes?

14. On a separate page in your own handwriting give a one page summary of why you want to attend Florida School of Preaching.

15. On the back of the separate page, in your own handwriting, provide a one page summary of John 3:1-21.