NEW RESIDENT APPLICATION. NEW RESIDENT APPLICATION. NEW RESIDENT APPLICATION. We appreciate your interest and look forward to hearing from you! Name * First Name Last Name Email * Phone (###) ### #### How Did You Hear About Immersion Discipleship House? * Why Do You Want To Apply To Immersion Discipleship House? * Current Address * Date of Birth * Gender * Male Female Marital Status * Single - Never Married Single - Divorced Married Widowed Separated Parent 1 Name * Parent 2 Name * Address * Parent 1 Phone Number * Parent 2 Phone Number * Additional Parental Information, If Parents Do Not Reside Together Home Church Name and City * Senior Pastor Name and Contact * Length of Attendance * Please List Service and/or Leadership Experience in the church or Ministry * Education Status * Please Check All That Apply Never Graduated High School Graduated High School/Earned High School Diploma/GED Currently In/Going Into My First Year of College Currently In/Going Into My First Second Year of College Currently In/Going Into My Third Year of College Currently In/Going Into My Fourth Year of College Currently In/Going Into My Fifth year of College Graduated College Not In School Other Check All That Apply To You In Regards To Your Vocational Status: * Never Had a Job Not Looking For Job Currently Looking For A Job Currently Working Other Do You Have Any Chronic Diseases or Physical Limitations Which Might Require Special Consideration or Facilities? * Do You Have A History of Mental Illness? * Do You Have A Criminal Record? * Do You Have Any Allergies (Food, Medication, Etc.) Which Might Require Special Consideration or Facilities? * Do You Use Tobacco or Drink Alcohol? Are You Using Other Drugs/Intoxicants? * Tell Us About Your Walk With The Lord. When Did You Get Saved? How Did It Look? What Does Your Devotional Life Look Like? * Please Inform Us of How You Would Be Able to Financially Support Your Time Here. * (Parents Are Paying, You Plan To Work To Support Yourself, Etc.) Have You Lived In A Community Environment Before? * Are You Willing to Room With 2 or 3 Other People? * We Want To Ensure Residents Have Compatible Roomates. Would You Be Able To Commit To Immersion Discipleship Home's Schedule? * Yes No By Checking Yes, I Am Agreeing To The Policies Set Forth From The Code of Conduct Page and Give My Permission To Complete A Background Check. * Yes No In Addition to your Application, Please Provide 1 Additional Pastoral Reference and 2 Personal References * Thank you!
