Cultivate 7-10 Day Application
Please fill out this form and click submit.
Legal Information
Name
*
Birthdate
*
Age at time of Mission
*
Gender
*
Please select one option.
Male
Female
Marital Status
*
Please select one option.
Single
Married
What is your nationality (Country of Citizenship)
*
Profile Information
Mobile Phone number
*
Email Address
*
This address will receive a confirmation email
Physical Address (No PO Box please)
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency Contact Name:
*
Emergency Contact Mobile Phone
*
Emergency Contact HomePhone
*
Emergency Contact Email
*
This address will receive a confirmation email
Relationship to Applicant?
*
Church Information
Do you attend a UPCI church?
*
Please select one option.
Yes
No (Application must be completed by a UPCI Licensed Presbyter
UPCI District?
*
Have you received permission from your pastor to apply?
*
Please select one option.
Yes
No
Pastors First Name:
*
Phone
*
Pastor Last Name:
*
Pastor or Church Phone
*
Church City & State
*
Have you followed the plan of salvation according to Acts 2:38? (Check all that apply)
*
Please select all that apply.
Repented of your sins and are striving to live a Christian lifestyle.
Baptized by immersion in the name of Jesus Christ for the remission of your sins.
Received the gift of the Holy Ghost with the evidence of speaking with other tongues.
In which church related activities have you been involved? (Check all that apply)
*
Please select all that apply.
Preaching
Choir Director
Teaching songs - Soprano, altp, and tenor parts
Singing in choir
Worship Leader
Praise Team
Singing Solos
Musical Instrument
Sunday School Teaching
Home Bible Studies
Drama/Sign Team
Sound Team
Media Team
Campus Ministry (P7 or CMI)
If you play an instrument, please specify the instrument and your level of experience. Optional
Do you feel a call to a particular Christian service? If yes, what?
*
Do you speak a language other than English? If yes, please list that language & your level of proficiency.
*
Medical Information
Do you have any medical experience or training?
*
Please select one option.
Yes
No
If Yes, please list the experience or training.
Medical conditions, medications or allergies?
*
Please select one option.
Yes
No
If Yes, please list medications and allergies (Animals, food, medicines, etc)
26. Are you receiving or have you received professional counseling or treatment for any mental, emotional, or physical illness?
*
Please select one option.
Yes
No
If you answered
27. Have you ever been in a behavioral rehabilitation program?
*
Please select one option.
Yes
No
If yes to this question, please explain (optional).
*
General Information
Have you ever been convicted of a crime?
*
Please select one option.
Yes
No
If
*
Are you aware that the MCM team may audit your social media?
*
Please select one option.
Yes
No
Please provide your social media links (names) here.
*
Submit
Description
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