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Application Form To be completed in Full PRINT OR TYPE Name________________________________________________________________ Last First Middle Date of Birth ___________________________________________________________ Day Month Year Social Security Number___________________________________________________ Total Number in household, including applicant _____ Total household annual Income_________________________________________ Church Membership and Length of Membership_______________________________________ Church Related Activities (with dates) ______________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Communities Activities: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contributions you wish to make to Ministry: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Greatest Strengths You Have to Give: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Significant Obstacles to be Overcome: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Two References, excluding family members: Name___________________________________________________________________ Addres__________________________________________________________________ Telephone Number________________________________________________________ Name___________________________________________________________________ Addres__________________________________________________________________ Telephone Number________________________________________________________ On a separate sheet of paper briefly discuss your interest in ministerial education. (You may refer to item 6 -11) Signature________________________________________________________________ Mailing Addresss_________________________________________________________ Phone Number ___________________________________________________________ SUBMITTED BY TO MINISTER ROSEMARY SIMMONS-BROWN
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