Heroes Semester Program Application

Heroes Semester Program Application

Heroes Semester program is a ministry of Christian Training Center International (CTCI)
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Which training program are you applying for?

Fall 2021 Spring 2022 Fall 2022
Full Name *

First Name Last Name
Birth Date *

Month Day Year
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email or Facebook *
Cell Phone *

Area Code Phone Number
Are you attending College/University? If so, where?
Present Level of Education *
Parent(s) Name *

First Name Last Name
Parent(s) Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Church *
Church Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mentor/Pastor

First Name Last Name
Phone

Area Code Phone Number
Will you be bringing your own vehicle? (yes/no) *
How did you hear about us? *

List any previous experiences in Christian ministry/programs either as staff or participant *
List 3 of your favorite activities: *
Are you currently certified in any of the following?

First Aid CPR Canoeing Rock Climbing Driver's License Swimming/Life-Guarding Repelling Other
Other Certifications:

Emergency Contact Information
First Contact *

First Name Last Name
Phone Number *

Area Code Phone Number
Second Contact *

First Name Last Name
Phone Number *

Area Code Phone Number
Primary Health Insurance *
Policy Number
Insured's Name

First Name Last Name
Medical Authorization

In case of sickness or an emergency, I authorize such medical procedures as are deemed necessary at the discretion of the CTCI staff, using qualified medical personnel or institutions.

I understand that the activities at CTCI are organized and safe. However, in the event of a mishap, I agree to assume the risk and liability of any injuries that I may suffer.
Electronic Signature *

First Name Middle Name Last Name
Electronic Signature *

First Name Middle Name Last Name
Date *

Month Day Year

Please write a brief testimony concerning your Christian faith. *
Please describe your current relationship with the Lord. *
Why are you interested in participating in the Heroes Semester program? *
What areas of your personal life do you feel you need to grow in the most this semester? *
What do you believe are your strengths in regard to the semester program? *

References
Please list three references (including pastor) whom you feel know you well. Please DO NOT include family members or peers.
Reference #1 *

First Name Last Name
Position/Relationship *
Phone Number *

Area Code Phone Number
E-mail or Facebook *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference #2 *

First Name Last Name
Position/Relationship *
Phone Number *

Area Code Phone Number
E-mail or Facebook *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reference #3 *

First Name Last Name
Position/Relationship *
Phone Number *

Area Code Phone Number
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Should be Empty:

Health Information