Christian Challenge International

Select Courses  
The Disciple's Heart Training Programã • Graduate Course [Tuition: $35.00]
Shepherd's Heart - Training for ministry. [Tuition $35.00]
Old Testament Bible Survey - Bible enrichment program. [Tuition $35.00]
New Testament Bible Survey - Bible enrichment program. [Tuition $35.00]
Vision for the Nations - Biblical and historical missions. [Tuition $50.00]
Conversational Spanish - For short-term mission trips. [Tuition $50.00]

Total Tuition

PERSONAL DATA:

1. Full name: Name you go by:

2. Date of Birth: Age Sex: Male Female

3. Residence: Street:

    City: State: Zip:

4. Mailing Address:

    Home Phone: Work Phone:

5. Occupation: Employer:

6. Marital Status: Single (never married) Married Widowed Separated or divorced

7. Spouse's name: Date of Birth: Age:

8. Are you a U.S. citizen? Yes No  If no, give nationality:

9. If U.S. citizen, do you have a particular cultural background?
        American Indian
        African-American
        Anglo-American
        Hispanic-American
        Oriental-American
        Other

10. Do you speak a language other than English? Yes No  Language and fluency:

11. Education - Indicate highest grade completed: 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade College 1 College 2 College 3 College 4 College 4+

12. List any degrees you have received:

CHURCH MEMBERSHIP AND CHRISTIAN EXPERIENCE:

13. Church Membership: Denomination:

14. Church Address (including City/State/Zip):
        Church Phone:

15. Pastor's Name: Do you attend regularly? Yes No 
        How long have you been a member?

16. Have you fully surrendered to the Lord? Yes No
        Have you been baptized? Yes No
        If answer to either question is no, explain:

17. Have you received any special Christian training? Yes No
        If yes, please explain:

18. Areas of experience:
        Pastor
        Associate/Assistant Pastor
        Evangelist/Missionary
        Youth Minister
        Sunday School Teacher
        Gospel music/choir
        Other (Explain):

GENERAL QUESTIONS:

20. Do you use tobacco, drugs or alcoholic drink in any form? Yes No
         If yes, explain:

21. Are you a member of any secret societies, orders, or lodges?  Yes No
         If yes, explain:

22. Do you have a physical handicap or are you under medication?  Yes No
         If yes, explain:

23. Do you wish to be involved in a ministry with Christian Challenge?  Yes No Unsure
         If yes, explain:

24. Have you completed this form in full? (Review.) Yes No
        Do you want an interview? Yes No

Email Address:   Date:

Any other comments: (Please indicate if this application is for Internet class.)