/* Start of CMSMS style sheet 'FSM Application' */ Guide to Completing the Freedom Application Thank you for applying to Freedom! May the Lord impart His wisdom and grace as you seek His direction. In order for us to process your application, we must receive all the following completed forms. If a question does not apply to you, write N/A in the blank. Husbands and wives enrolling as students must complete separate applications. Please make a copy for your spouse if applicable. 1) Entry Application Form. Please answer all questions and return the form along with the other items listed below. 2) Personal History. Please prayerfully and concisely answer the following questions on a separate sheet of paper (print or type) and attach it to your application form if you need more room. Your answers will be significant in the application process. a) Please describe your conversion experience and present spiritual relationship with the Lord. (not more than one page) b) What areas of your character are you presently seeking God to further develop and improve? c) Please describe your spiritual and/or ministry goals, including missionary service goals. d) Please describe your relationship with your local church, i.e. areas of ministry, service leadership experience, gifts and abilities. e) Please describe your business, professional, missions, or other significant experiences. f) Please describe your relationship with your family and how they feel about your plans to enroll in Freedom. 4) Reference Forms. After you sign each form and enter the course date, give one form to your pastor, one to an employer or teacher, and one to a friend. Ask them to complete the form and mail it directly to the Poieo address. Please include a list of their names, addresses and telephone number with your application. We must receive at least two of these reference forms (Pastor’s form must be one) before we can process your application. 5) Health Form. Please complete this form and return it directly to the Poieo. These forms must also be submitted for children if accompanying you. Important: All students are encouraged to apply early as course may fill up many weeks in advance. US citizens should apply no later than three weeks prior to the start of the school, and for non-US citizens, no later than two months, due to visa processing. Send all forms to: New Auburn Seventh Day Baptist Church, Freedom School of Ministry, 503 S East St, New Auburn, WI 54757 Phone: (715) 237-2616, E-mail: pastor@nasdbc.org Date of Application: ________________ School applying for: ____ Fall ___ Spring Year ______ Mr./Mrs./Miss ________________________________________ Current Address: Street/PO Box_____________________________________________ City, State, Zip ____________________________________________ Phone _____________________ Fax Number _____________ E-mail address_____________________ Age __________ Birthday: Month ____ Day ____ Year ____ Sex: M __ F __ Birthplace (city and country) ________________________________ Citizenship ______________________ Social Security Number (US) _______-_____-______ Do you have a Passport: ___ Yes ___No Visa: ___Yes ___No Marital Status: ___ Single ___ Engaged ___ Divorced ___ Separated ___ Remarried ___ Widowed ___ Married Anniversary: Month ___ Day___ Year___ Spouse’s name ______________________________________________ Names of Children :___________________________________________ Will they be coming ? (Each will incur a cost) ____Yes ____No Background Information Does your pastor know you are sending this application? Yes __ No __ Is he/she in agreement with your plans? Yes __ No __ Pastor’s Name _________________________________ Church name ______________________________________________ Street/PO Box Address_______________________________________ City, State, Zip_____________________________________________ Church E-mail address __________________________ Denomination __________________________________________________ How long have you attended the above church? _______________________ How long have you been a “born-again” Christian? _____________________ Previous ministry/missions experience (Please list when, where, program and leader) _______________________________________________________ What is your purpose in applying for the Freedom? _____________________________________________________________ Occupation ___________________ Occupational Skills _________________ Musical ability and other talents ___________________________________ Spiritual Gifts __________________________________________________ Highest Educational Level Completed (date completed) _________________ Languages (list in order of proficiency) ______________________________ Financial Information Do you have your complete school fees? Yes __ No __ If no, from what source will they come? ________________________________________________________ Do you have any outstanding debts? Yes __ No __ If yes, please explain. ______________________________________ I certify that all this information is complete and accurate. Applicant’s Signature ______________________________ Date__________ Release Form Release of Liability: I/We do hereby release New Auburn Seventh Day Baptist Church, its ministry outreaches (including Freedom), its staff, agents, and volunteer assistants from any liability whatsoever arising out of any injury, damage, or loss which may be sustained by said person(s) during the course of involvement with Freedom. Applicant’s Signature _________________________ Date____/ ____/ ____ Acknowledgment of Financial Responsibility: I understand that payment of the required school tuition fees must be made in US currency prior to or upon my arrival, unless otherwise approved in writing by the School Leadership before my departure for New Auburn. Further, I agree to meet in a timely manner, prior to the completion of school, all expenses incurred during my involvement with Freedom. Applicant’s Signature _________________________ Date ____/____/____ Consent for Treatment: In case of emergency, I/We hereby agree to the performance of such treatment, including anesthesia and surgery, that the attending doctor or physician may deem necessary. I/We also accept full responsibility for expenses related to medical care. Applicant’s Signature _________________________ Date ____/ ____/ ____ Emergency Information: In case of emergency, contact _________________________________ Relationship _____________Phone Number ________________ Specify any drugs you are allergic to ____________________________ I have completed all portions of this application accurately for admission to the program for which I am applying. I have read the policies and if I am accepted by Poieo, I will abide by the spirit, rules, and schedules of the program. Applicant’s Signature _________________________ Date ____/____/____ Confidential Health Form Name ________________________________________________________ School applying for: ___ Fall ___Spring Year_____ Your Address: _______________________________________________________ Do you have medical insurance? ___ yes ___ no If yes, name of Insurer____________________ Policy Number___________ Personal History: Height _______ Weight _______ Blood Type _______ Have you ever had, or do you have, any of the following? ___Allergy: _________ ___Surgery: ___Jaundice ___Penicillin ___Appendectomy ___Hepatitis ___Sulfonamides ___Tonsillectomy ___Kidney Disease ___Serum ___Hernia Repair ___Gall bladder problems ___Intestinal troubles ___Broken bones ___Recurrent diarrhea ___Skin Conditions ___Dislocation of joints ___Shortness of breath ___Eye trouble ___Rheumatism/Arthritis ___Ulcers ___Ear trouble ___Back problems ___Mental/nervous disorder ___Recurrent Headaches ___Paralysis ___Depression ___Fainting spells ___Head Injury ___Insomnia ___Epilepsy ___Hay fever ___asthma ___Heart trouble ___High Blood Pressure ___Low Blood Pressure ___Weakness ___Venereal Disease ___HIV ___Diabetes ___Cancer ___Anxiety attacks ___Other-specify ___________________________________________ ___Other-specify ___________________________________________ FEMALES ONLY ___Irregular periods ___Severe cramps ___Hysterectomy Are you pregnant? ___Yes ___No Do you have any special dietary needs? __________________________________ Are you now under doctor’s care for any condition? ___ no ___ yes (specify) _____________________________________________________________ Are you taking medication at this time? ___ no ___ yes (specify) _____________________________________________________________ Do you have any handicaps? ___ no ___ yes (please describe) _____________________________________________________________ Do you now or have you ever had any involvement with smoking, drugs, or alcohol abuse? If yes, please list which ones and the most recent dates of involvement. __________________________________________________ Applicant’s full name __________________________________________ Please attach a copy of your shot records. To the Physician: The above named person has applied for service with Freedom. This is a Ministry Develop Training School in which there may be some strenuous physical exertion. Please answer the following questions regarding the applicant’s health. Thank you for your time and honesty. 1. Would he/she be able to walk 3-4 miles per day? ___ yes ___ no 2. Would you consider the applicant to be in good health? ___ yes ___ no 3. Do you certify the applicant to be non-contagious? ___ yes ___ no NOTE: Please use the space below to make additional comments regarding the applicant’s health or special limitations affecting physical, mental, or emotional capabilities. Comments/Concerns: Doctor’s signature or stamp_______________________________________ Doctor’s full name printed ___________________________ Date ________ Office Address: Street/PO box ____________________________________________ City, State, Zip ___________________________________________ Phone # ________________________ email ___________________ FAX # __________________________ Thank you for your time and honesty. God bless you! Pastor’s Reference Form (p.1) To the Applicant: Please complete the information below and provide a stamped envelope addressed to FSM for the person completing the reference. Name of Applicant _____________________________________________ School applying for: ____ Fall ___ Spring Year ______ ____ Summer Mini-session ___________________ I, the above named applicant, WAIVE any right I have to read or obtain copies of this recommendation knowing that this waiver is NOT required as a condition for admission. Applicant’s signature ____________________________Date ___________ The above applicant has applied for participation in Freedom, a ministry development training school emphasizing short-term mission opportunities. Its purposes include training, challenging and channeling Christians to fulfill Christ’s command: “Go ye into all the world and preach the gospel to every creature.” (Mark 16:15) Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Thank you for your assistance. Please check the following and comment where necessary. Superior Above Avg. Average Below Avg. Inferior Initiative Social Adaptability Concern for others Ability to follow Leadership Judgment/Decision Making Emotional Stability Health Personal Appearance Comments: ___________________________________________________________________ Please check the appropriate response. Mental ability: __quick to comprehend __average __delayed Industrious: __hard worker __average __lazy Reliability: __outstanding __average __unreliable Cooperativeness: __flexible __average __rigid Flexibility: __open to change __average __unyielding Christian Character: __well-balanced __average __unstable Disposition: __cheerful __average __passive Punctuality: __punctual __average __often late Financial Responsibility: __honors obligations__average __neglectful Comments:____________________________________________________ Pastor’s Reference Form (p.2) 1. How well do you know the applicant? ___very well ___ well ___ casually 2. In what situations have you observed the applicant? __at home __at work __in social activities __in church relationships 3. How long has the applicant attended your church? _______________ 4. In what activities has the applicant participated since attending your church? ________________________________________________ 5. In your association with the applicant, what has been the level of commitment you have seen exemplified? ___Faithful ___Average ___Inconsistent ___other __________ Please give details:__________________________________________ 6. Were you aware of the applicant’s intention to participate in this Poieo program? ___ yes ___ no 7. Does he/she display high moral standards? __ yes __ no 8. Is he/she prejudiced in any way? __no __yes (please explain) _____________________________________________________ 9. With reference to his/her Christian service, do you consider the applicant to be: __dedicated __average __casual 10. In your consideration, which of the following would best describe the applicant’s Christian experience? _mature _contagious _genuine & growing _over emotional _superficial Comments:_________________________________________________ 11. Overall, what do you consider to be the applicant’s strong points? __________________________________________________________ 12. Please comment on the applicant’s family background (if known) __________________________________________________________ 13. In your opinion, what are the applicant’s motives for applying to Freedom? __________________________________________________________ 14. What could Freedom do to aid in the applicant’s personal development? __________________________________________________________ 15. Please add any other remarks concerning medical, psychological, drug/alcohol use or other areas of his/her life that we should know more about, to be of better service to him/her. __________________________________________________________ 16. Would you recommend the applicant for acceptance by Freedom? __yes __with some reservation (please explain) __no (please explain) __________________________________________________________ 17. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character? __ no __ yes (please explain) __________________________________________________________ 18. Would your church be willing to support this applicant? __financially __prayerfully Comments: _______________________ I have known ___________________________ for ____ years and believe that he/she possesses the qualities indicated above. Signed ________________________________ Date ___________________ Name (please print)__________________________ Position: Pastor Address ___________________________________________________ Phone _______________________ E-mail address ____________________ Thank you for your time and honesty. God bless you! Reference Form - Page 1 To the Applicant: Please complete the information below and provide a stamped envelope addressed to Registrar for the person completing the reference. Name of Applicant: ______________________________________________ School applying for: ____ Fall ___ Spring Year ______ I, the above named applicant, WAIVE any right I have to read or obtain copies of this recommendation knowing that this waiver is NOT required as a condition for admission. Applicant’s signature _____________________________ Date___________ The above applicant has applied for participation in Freedom, a ministry development training school emphasizing short-term mission opportunities. Its purposes include training, challenging and channeling Christians to fulfill Christ’s command: “Go ye into all the world and preach the gospel to every creature.” (Mark 16:15) Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Thank you for your assistance. Please check the following and comment where necessary. Superior Above Avg. Average Below Avg. Inferior Initiative Social Adaptability Concern for others Ability to follow Leadership Judgment/Decision Making Emotional Stability Health Personal Appearance Comments _____________________________________________________________ Please check the appropriate response. Mental ability: __quick to comprehend__average __delayed Industrious: __hard worker __average __lazy Reliability: __outstanding __average __unreliable Cooperativeness: __flexible __average __rigid Flexibility: __open to change __average __unyielding Christian Character: __well-balanced __average __unstable Disposition: __cheerful __average __passive Punctuality: __punctual __average __often late Financial Responsibility: __honors obligations __average __neglectful Comments:____________________________________________________ Reference Form - Page 2 1. What’s your relationship to the applicant? __employer __teacher __friend 2. How well do you know the applicant? __very well __well __casually 3. In what situations have you observed the applicant? __home __work __school __social activities __church ministries __other:______ 4. Does he/she display high moral standards? __ yes __ no 5. Is he/she prejudiced in any way? __no __yes (please explain) __________________________________________________________ 6. With reference to his/her Christian service, do you consider the applicant to be: __dedicated __average __casual 7. In your consideration, which of the following would best describe the applicant’s Christian experience? _mature _contagious _genuine & growing _over emotional _superficial Comments: __________________________________________________________ 8. Overall, what do you consider to be the applicant’s strong points? __________________________________________________________ 9. Please comment on the applicant’s family background (if known) __________________________________________________________ 10. In your opinion, what are the applicant’s motives for applying to Freedom? __________________________________________________________ 11. What could Freedom do to aid in the applicant’s personal development? __________________________________________________________ 12. Please add any other remarks concerning medical, psychological, drug/alcohol use or other areas of his/her life that we should know more about, to be of better service to him/her. __________________________________________________________ 13. Would you recommend the applicant for acceptance by Freedom? __yes __with some reservation (please explain) __no (please explain) __________________________________________________________ 14. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character? __ no __ yes (please explain) __________________________________________________________ 15. Would you be willing to support this applicant? __financially __prayerfully Comments: _______________________ I have known ___________________________ for ____ years and believe that he/she possesses the qualities indicated above. Signed __________________________________________ Date _________ Name (please print)_______________________________________ Relationship with Applicant: _______________________________________ Address ___________________________________________________ Phone #______________________ E-mail address____________________ Thank you for your time and honesty. God bless you! /* End of 'FSM Application' */