Project12.us

PROJECT 12 BASIC APPLICATION FORM
(also contains PROJECT 12 DISCIPLESHIP PASTOR / LEADER REFERENCE FORM)

Thank you for your interest in Project 12 Discipleship Training.

Please cut and paste, email, fax, or print out and mail to Project 12.

If you need more room than we have provided, please add more space (or paper) and include your full responses in the same email, fax or mail with this application. The more you and your pastor or leader can tell us, the better!

NAME _____________________________________________________

M/F __________ AGE ___________ DATE OF BIRTH_______________

MARITAL STATUS __________ OCCUPATION ____________________

ADDRESS _________________________________________________

CITY ___________________________STATE _____ ZIP____________

COUNTRY __________________________

PHONE ________________________ EMAIL ________________________

CITY OF BIRTH (IMPORTANT FOR INTERNATIONAL VISITORS)

____________________________________________________________

>>> EMERGENCY INFORMATION:

CONTACT PERSON ___________________________________________

RELATION ___________________________________________________

HOME # _______________ WORK # _______________

If you have children, please list:

NAME _________________________________AGE _______ M/F ______

NAME ________________________________ AGE _______ M/F ______

You understand that tuition for Project 12 over the 10 month program will be $3000, payable either in full or in periodic amounts you can afford. Further, should you exit the program prematurely, you agree that you forfeit that semester’s tuition. (If finances are impossible for you, limited scholarships may be available.) If you agree with this, please sign your name below:

_________________________________________________________________

How did you find out about Project 12? _________________________________

_________________________________________________________________

What are your talents, hobbies or interests? _________________________

_________________________________________________________________

Please tell us how you became a Christian, as well as a little about yourself (you may wish to include what areas you are looking to grow in while you're here) so that we can better address your needs:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

What do you hope to accomplish during your time in Project 12? Please list any specific goals you might have, as well as general aspirations.

_____________________________________________________________________

In what areas and ways have you been active in your home church or fellowship?

_____________________________________________________________________

Please provide the following information about your pastor, counselor, small group leader or fellowship leader for reference purposes. We need at least one dependable leader or fellowship leader for reference purposes. Additionally, we need at least one dependable character reference for you to be considered for Project 12 discipleship. Two or more would be better, if you can provide them.

Name ____ _______________ Phone ________________

Relationship_____________

Name ___________________ Phone _______________

Relationship______________

Name ___________________ Phone ________________

Relationship_____________

Travel Arrangements:

______________________________________________________________

Do you have any specific medical needs that we should be aware of? If so, please explain (and list any medication you are currently taking.)

_____________________________________________________________________

Have you had treatment for mental or emotional disorders? Please include information about any drug or other therapy you've received.

___________________________________________________________________

Have you ever been prosecuted for sexual abuse of any kind? If so, please clarify.

___________________________________________________________________

Have you ever been addicted to illegal drugs? If yes, please indicate which drugs and treatment you've received.

___________________________________________________________________

Are you now or have you been incarcerated or placed on probation? If so, please explain.

___________________________________________________________________

Thank you for helping us get to know more about you! Please pray for God to guide you -and- us in the decision process. We now ask you to wait to hear from us. We'll be sending you an email or postcard regarding this year's Project 12 program and your possible involvement in it.

God's Grace and Guidance to us all!

Sincerely,

The Project 12 Admissions staff

Email: p12office<at>project12<dot>us (Change previous bracketed to an '@' symbol and a '.' to send)

Fax: Project 12 Admissions 773.989.2096

Mail:
     Project 12 Admissions
     920 W. Wilson Ave.
     Chicago, IL 60640 U.S.A.

PROJECT 12 DISCIPLESHIP PASTOR / LEADER REFERENCE FORM

Website: www.project12.us (this site)

Email: p12office<at>project12<dot>us (Change previous bracketed stuff to an '@' symbol and a '.' to send)

Fax: Project 12 Admissions 773.989.2096

Mail: Project 12 Admissions / 920 W. Wilson Ave. / Chicago, IL 60640 /U.S.A.

Thank you for your interest in the spiritual life of the person we are referencing in this document!

Please be as direct and candid as possible in answering our questions with regard to the applicant for this season's Project 12 Discipleship Training program. We also ask you to pray for God's guidance for our staff regarding our decision as to whether the applicant should be included in this term. We deeply appreciate your prayers, and ask you to give whatever input the Lord may lead to the applicant regarding their decision.

You may cut and paste this form and send it to the above addresses or number via email, fax or mail, whichever you find most suitable.

Thank you for assisting us in the application process.

The Grace of Jesus to you,

Glenn Kaiser, Director Project 12

Please give us your name: _________________________________________

Phone Number(s): _______________________________________________

Email:

Church, Fellowship or Ministry Association Name:

Applicant's Name:

Applicant's Current Place of Residence:

Relationship to Applicant:

Please state why you think Project 12 may be a good choice for the applicant at this stage of their life?

Do you believe the applicant is serious about their Christian walk?

What sort of activities (spiritual as well as social or work-related) has the applicant been involved with during your contact with them?

What would you list as the applicant's gifts?

In your view, what areas of growth may be needed?

Thank you so very much for your honest responses to these questions! God Bless you in your service to the Lord Jesus!

Sincerely,

The Project 12 Admissions Staff

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