Youth Application Youth Application Today's Date * MM DD YYYY Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Date of Birth * MM DD YYYY Sex * Male Female Select 1 * Single Married Separated Divorce Citizenship * Highest Education * High School High School Address Address 1 Address 2 City State/Province Zip/Postal Code Country Highest Grade Completed 9 10 11 12 Date of GED MM DD YYYY College or Bible School Major Degree AA AS BA BS MA MS M. DIV DR Current Employer * Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Phone # Personal Reference * First Name Last Name Personal Reference Phone # * (###) ### #### Pastoral Reference * First Name Last Name Pastoral Reference Phone # * Name of Current Church * Church Address * Address 1 Address 2 City State/Province Zip/Postal Code Country I give permission for the photographs or videotapes of my person, taken during activities in the program to be used in promotion of the program, to be used in promotion of the program, Victorious Living CLC ministries presentation, and / or other lawful purpose. I waive any right that I may have to inspect and / or approve the finished products * I Accept I Don't Accept Please describe how you came to know Christ. Explain your current relationship with the Savior and your daily devotion routine. * Thank you!
