Application
for
1. Date of
Application ________________________ Date You Expect to Enroll
_______________________________
2. Name
____________________________________________________ Birth date
__________________________
3. Address
________________________________________________________ Phone
_______________________
4.
5. Social
Security Number: __________________________ Can you come for a personal
interview? ________________
6. Place of
Birth
_________________________________________________________________________________
7. Name of
Permanent Contact _______________________________________________
Phone__________________
8. Address of
Permanent Contact
9. Present
Congregation
__________________________________________________________________________
10. Address
____________________________________________________________________________________
11.
12. Preacher
____________________________________________________ Phone
___________________________
13. Elder or member
acquainted with you _____________________________________Phone
_____________________
14. When were you baptized?
_______________ Where? _____________________ By Whom?
___________________
15. Marital Status: _____Single _____Married _____Separated _____Previous Marriage
Annulled
____Divorced
______Divorced and Remarried; ______Widowed; ______Widowed and
Remarried
(Explain)
___________________________________________________________________________________
16. Wife's name
________________________________________________________ Birth date
_________________
17. Wife's Marital
Status:
_____Previously Divorced _____Previous Marriage
Annulled
_____Married Only Once
_____Divorced and Remarried; (Explain)____________________________________________________________
18. When baptized?
___________________ Where? ______________________ By whom?
______________________
19. Do you have children?
__________________________________________________________________________
20. Names and ages of
children
______________________________________________________________________
___________________________________________________________________________________________
21. Educational
background. Grade level obtained
________
List schools; colleges attended, and years attended (Please arrange to
have transcripts sent to ETSPM)
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
22. Have you had to
withdraw from any school or college?
_________________________________________________
If yes,
explain._________________________________________________________________________________
23. Type of employment last
three years _____________________________ Where?
___________________________
24. Employer's name and
address
_____________________________________________________________________
25. May we contact your
employer (or last employer if not now employed) for a reference? _____Yes _____No
26. What experience do you
have in the work of the
Church?
___________________________________________________________________________________________
___________________________________________________________________________________________
27. Could you handle a
preaching assignment, if such were available?
_________________________________________
28. Could you lead singing
for a congregation?
__________________________________________________________
29. Do you or anyone in
your household use tobacco? _____ If so, would you/he/she quit before entering
school? ______
30. Do you have any
physical handicap that might hinder you as a student? _____Yes
_____No
If yes,
explain_________________________________________________________________________________
31. Have you been in
military service? ______________________________ Honorable discharge?
_____Yes
_____No
If no, explain:
_________________________________________________________________________________
32. Are you qualified for
V.A. Educational Benefits?
______________________________________________________
33. Financial
Information:
a.
Referring to the enclosed Estimated Student Expense form, what do you
estimate your monthly needs will be? $____
b. Can you fully
support yourself without outside assistance? _____Yes
_____No
c. If no, can
you raise the estimated expenses from family, friends, churches, etc.? _____Yes
_____No
d. If no, you may
want to request a Financial Assistance Application in an effort to qualify for
limited assistance through
the school. Do you wish to receive a Financial
Assistance Application?
_____Yes
_____No
(Note: Available assistance is limited and
should be requested only after extensive effort has been made to find
support
elsewhere. You should not assume
that the school will automatically provide assistance.)
34. References: List five references, giving their names and addresses (Please Print):
1)
_________________________________________________________________________________________
2)
_________________________________________________________________________________________
3)
_________________________________________________________________________________________
4)
_________________________________________________________________________________________
5)
__________________________________________________________________________________________
35. Have you ever been
convicted of any violation of the law? (Minor traffic violations excepted) ____________________
36. In
the space below, write a brief statement explaining why you want to attend the
37. Upon
being accepted for the
1) To abide by
all rules and regulations of the EAST
2) To do my best
to complete all school work assigned, approaching such seriously and
prayerfully. I will attend all
classes and chapel sessions faithfully, unless hindered by circumstances beyond
my control.
3) Unless called
away by preaching engagement, or other necessary circumstances, I will
faithfully attend all services of
Signed_____________________________________________________Date
__________________________
MEDICAL
INFORMATION ON THE STUDENT
In
order to aid us in helping YOU in emergency situations during your time as a
student, please complete this form:
Blood
Type _________________
Explain
any history of health problems
__________________________________________________________________
What
is the date of your last physical
examination?_________________________________________________________
LIST
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
KNOWN ALLERGIES TO MEDICATIONS: ______________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Have
you any history of ______emotional problems, ______drug addiction, ______alcohol
addiction? If
yes:
1. Have you
been under medical treatment for this problem? _____Yes
_____No
2. Have you
been hospitalized in connection with this problem? _____Yes
_____No
If
yes, When?
________________________________________________________________________________
3. How long
since your last bout with this problem?
______________________________________________________
4. Have you
been through a formal rehabilitation program? _____Yes
_____No
a. If yes,
which program?
______________________________________________________________________
b. When?
__________________________________________________________________________________
c. Give the
name, address, and phone number of the physician or professional counselor who
worked with you in this
area.
________________________________________________________________________________________
________________________________________________________________________________________
If
you answered "yes" to any of the above questions, please state how you think you
can handle the stress of a concentrated study program in view of this
problem.
INFORMATION
REQUIRED ON THE STUDENT WIFE
What
are your feelings about your husband attending the East Tennessee School of
Preaching and Missions and devoting his life to preaching the gospel?
______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I
have read the catalog and discussed the expectations and responsibilities
involved in our attending East Tennessee School of Preaching, and I am in agreement with my
husband's decision. I will
participate to the best of my ability in all activities and in classes designed
for wives.
Signed__________________________________________________________Date____________________________
MEDICAL
INFORMATION ON THE STUDENT WIFE
In
order to aid us in helping YOU in emergency situations during your time as a
student wife, please complete this form:
Blood
Type _________________
Explain
any history of health problems:
What
is the date of your last physical examination?
LIST
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
KNOWN
ALLERGIES TO MEDICATIONS:
______________________________________________________________
Have
you any history of _____emotional problems, _____drug addiction, _____alcohol
addiction? If
yes:
1. Have you
been under medical treatment for this problem? _____Yes
_____No
2. Have you
been hospitalized in connection with this problem? _____Yes
_____No
If yes, When?
________________________________________________________________________________
3. How long
since your last bout with this problem?
______________________________________________________
4. Have you
been through a formal rehabilitation program? _____Yes
_____No
a. If yes,
which program?
______________________________________________________________________
b. When?
__________________________________________________________________________________
c. Give the
name, address, and phone number of the physician or professional counselor who
worked with you in this
area.
________________________________________________________________________________________
If
you answered "yes" to any of the above questions, please state how you think you
can handle the stress placed upon you by your husband's concentrated study
program in view of this
problem.