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Friday, May 9, 2008

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Raffa Discipleship School - Speaking to the Heart of Man!

Application Form

For a print out version, click here.

* Required Fields

PERSONAL DATA:

*First Name:
*Last Name:
*Address:
Address 2:
*City or Town:
*State/Province:
Country:
*Zip Code:
Phone:
Fax:
*Email:

Marital Status:
Number of Children:
Which campus will you attend?
How did you learn about RDS?

Define Disciple:

FAMILY DATA:
Spouse Name:
Has your spouse accepted Christ as his/her personal Savior?	Yes No
Does your spouse approve of you attending RDS?	Yes No
RELIGIOUS DATA:

Pastor's Name
Church Name
City
State/Province
Work Phone
FAX
E-mail
URL

How long have you been attending?
Are you a member of the church?	Yes No In The Process
Have you accepted Christ as your personal Savior?	Yes No
EDUCATIONAL DATA:
Education (pick the highest grade completed)?
How many years of college?
The type of degree you received?

Please provide a testimony of your Christian experience (salvation, encounters with the Holy Spirit, etc.)?

Please explain your personal life goals (spiritually, educationally, physically, financially, emotionally, socially)?

MEDICAL CONSENT:
I, the undersigned, do hereby state that on the date indicated, I do hereby grant full permission to Raffa Discipleship School, or any related or consulting physician to render or give emergency medical aid, care or treatment that is deemed necessary. I also state that, should extended hospitalization be required, I grant complete permission for such care and treatment to be given. I also state that by granting such permission, I absolve Raffa Discipleship School of any financial liability pertaining to such medical treatment or hospitalization.

*Signature:
Date:

STATEMENT OF TRUTH:
I understand that all items submitted to Raffa Discipleship School as part of the application process become the permanent property of Raffa Discipleship School and will not be returned to me.

I hereby state that the information contained in this application is correct and true. If Raffa Discipleship School is notified that any information contained herein is false, it will be grounds for my immediate denial or dismissal. I also understand that completion of this application in no way guarantees or implies acceptance and/or enrollment as a member of Raffa Discipleship School.

*Signature:
Date:

*Security Code:

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