| E-mail Address: * | |
| Name (First, Middle and Last): * | |
| Home Phone: * | |
| Cell Phone: * | |
| Work Phone: * | |
| Mailing Address (street, city, state, zip, country (or PO Box) : * |
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| Permanent Address: (If different) | |
| Birth date (mm/dd/yyyy): * |
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| Country of Birth: * | |
| Country of Citizenship: * | |
| Are you US citizen * |
YES
NO |
| If NO, what is your status? * |
|
| If Permanent Resident, A #: * |
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| If Student Visa, expiration date of visa (month / day / year): * |
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| Native Language: * | |
| List any foreign languages you speak fluently: | |
| If you are a dependent, please complete this section: | |
| Father: First and Last Name, Address, Phone #: * | |
| Mother: First and Last Name, Address, Phone #: * | |
| Who to contact In case of emergency (Name and Phone #): * | |
| Marital Status: * | |
| If married, spouse name: * | |
| How many children do you have? | |
| Have you ever been convicted of a crime other than a traffic violation? * | YES
NO |
| If, YES, please explain | |
| Are you bringing a vehicle? | YES
NO |
| I wish to stay in the apartments provided by LIFE. I understand I will share the room with others of the same gender. * | YES
NO |
| What is your sleeping preference? (Morning): * | |
| (Night): * | |
| Share some of your favorite speakers and why you like them: * | |
| School: * | |
| Degree: * | |
| Date (month / day / year): * | |
| Have you ever been dismissed from any educational institution? * | YES
NO |
| If so, please write an explanation: | |
| Chuch Membership (city, state, country): * | |
| Church phone #: * | |
| Name of Pastor: * | |
| Pastors phone #: * | |
| How do you understand the scriptural basis for your salvation?: * | |
| Describe your own conversion experience: * | |
| What is your main objective in attending LIFE? * | |
| Do you understand the fundamental beliefs and practices of the Seventh-day Adventist Church? * | YES
NO |
| Do you accept the terms and conditions of Operation MissionLIFE 2009? * | Yes, I accept |
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| * Required | |