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?

Spring 2023 (10 Weeks)Fall 2023 (10 Weeks)
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email or Facebook*
Cell Phone*

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

First NameLast Name
Parent(s) Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Church*
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mentor/Pastor

First NameLast Name
Phone

Area CodePhone 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 AidCPRCanoeingRock ClimbingDriver's LicenseSwimming/Life-GuardingRepellingOther
Other Certifications:

Emergency Contact Information
First Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Second Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Primary Health Insurance*
Policy Number
Insured's Name

First NameLast 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.
Covenant

While serving in the CTCI Semester Program, I agree to adhere to the highest moral standards in conduct and dress and to submit to the oversight of the CTCI Staff. I agree there should be NO use of alcohol, tobacco, or illegal drugs. As the variety of classes, activities, and responsibilities present themselves, I am willing to do any tasks assigned.

I understand that in addition to assigned duties, an integral part of the Heroes Semester will be specialized training activities in which I will participate.

I will not bring anything to CTCI that will detract from the goal of personal growth and wholesome activities. I will obey the rules and submit to the authority of the CTCI staff.
Electronic Signature*

First NameMiddle NameLast Name
Electronic Signature*

First NameMiddle NameLast Name
Date*

MonthDayYear

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 NameLast Name
Position/Relationship*
Phone Number*

Area CodePhone Number
E-mail or Facebook*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference #2*

First NameLast Name
Position/Relationship*
Phone Number*

Area CodePhone Number
E-mail or Facebook*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference #3*

First NameLast Name
Position/Relationship*
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty:

Health Information