School of Revival Application Fillable 2012 by GJ3Au1

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									                                   APPLICATION FORM
                         PLEASE PRINT OR TYPE ALL YOUR ANSWERS




Place one photo here (Please enclose a second photo)
Date of Application:           M ____ D ____ Y _______


                                   PERSONAL INFORMATION


Name: (      Mr.,      Mrs.,        Miss.,) _____________________________________________________
Telephone numbers:
       Home # (______) ______-________             Work# (______) ______-________
       Fax# (______) ______-________               E-Mail ____________________________________
Current Address:
__________________________________________________________________________________________________
______________________________________________________________________
Permanent Address:
__________________________________________________________________________________________________
______________________________________________________________________
(Please print as it would appear on a mailing label for your country)


                                         Emergency Contact



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Name:      __________________________________________________________________________
Address:   __________________________________________________________________________
Phone:     (______) ______-________             Relationship to you: ________________________


Application fee enclosed?        $50US          I am applying for: ________ Year
How did you hear about this School?                  Friend                       Conference
                                                     Advertisement
Webpage
                                                     Other
Have you attended any other Ministry School?                  Yes         No




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                                           Family Details


Birth date:    M ____ D ____ Y ________            Age: ____
Sex:                Male                  Female
Status:             Single                Engaged                     Married
                    Remarried             Divorced
                    Separated             Widowed
(on a separate piece of paper, please give a brief history of the circumstances, including
dates, if you have been separated, divorced, remarried, widowed or are engaged)


Spouse's name:      ___________________________________________________________________
Birth date:         M ____ D ____ Y ________       Age: ____
Nationality:        ________________________       Birth place: _______________________________
Date of Marriage: M ____ D ____ Y ________         (prospective date if engaged)
Names and ages of your children:
____________________________________________________________________________________
                                       Passport information
Name on passport ___________________________________________________________________
Citizenship __________________________________________________________________________
City or Country where Passport was issued
____________________________________________________________________________________
Passport number ________________________           Date of issue M ____ D ____ Y ________
Expiry Date         M _____ D ____ Y _______
Nationality _______________________________        Birth place ________________________________


Do you have a criminal record?            Yes          No
(This question is for immigration purposes only)


                              Social and Health Insurance Numbers


Social Insurance # _________________________       Health Insurance # _________________________


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Health Insurance Company ____________________________________________________________


                                   High School Transcript


Please send a certified copy of your completed high school transcript with your application
form.


Transcript enclosed?      Yes




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HEALTH FORM


TO THE APPLICANT: This information will be treated confidentially and separately from
your academic records. When you complete the first part of this form please have your
doctor complete the rest. Please answer all these questions in ink or by typing in
ENGLISH.


Name ______________________________________________________________________________
Social insurance / Security number _____________________________________________________
Citizen of ___________________________________________________________________________
Medical insurance number ____________________________________________________________
Please briefly explain your medical insurance coverage
____________________________________________________________________________________
Medical coverage is essential if you come from a country other than USA. If you are
accepted by the school and do not currently have medical insurance this MUST be
arranged BEFORE arriving in USA.


                                      PERSONAL HISTORY


Please answer all the following questions.
Have you ever had, or do you have, any of the following? If Yes, please give the details on
a separate sheet. Please tick as Yes in the following slots.


    Skin condition               Heart trouble               Jaundice
    Eye trouble                  Hepatitis                          HIV
    High blood pressure          Head injury                 Low blood pressure
    Intestinal problems          Arthritis                   Recurrent diarrhea
    Recurrent headache           Back problems                      Diabetes
    Epilepsy                            Kidney disease                     Fainting spells
    Dislocation of joints        Broken bones                Mental / nervous disorder
    Anemia                       Venereal disease                   Stomach / duodenal ulcer

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     Weakness                    Tumor / cancer                     Gall bladder problems
     Paralysis                          Surgery                     Insomnia
     Appendectomy                Tonsillectomy               Shortness of breath
     Hay fever                          Asthma                      Hernia repair
     Ear Trouble                 Allergies, including food allergies
     Other list below
____________________________________________________________________________________


Are you at present under the care of a doctor for any condition?                    Yes
No
If Yes, please specify:
____________________________________________________________________________________


Are you taking any medication at this time?           Yes           No
If Yes, please specify:
____________________________________________________________________________________




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Are you allergic to any medications?            Yes          No
If Yes, please specify:
____________________________________________________________________________________


Do you have a history of emotional instability or psychiatric treatment?          Yes
No
If Yes, please specify:
____________________________________________________________________________________


Do you now, or have you ever, receive compensation for disability from any source?
     Yes           No
If Yes, please specify:
____________________________________________________________________________________


Do you have any physical impairments, handicaps or health conditions which require
special attention including food allergies?                  Yes           No
If Yes, please describe:
__________________________________________________________________________________________________
______________________________________________________________________


What is your blood type ? ____________________
Are you under weight?              Yes          No
Are you over weight?               Yes          No      If so, by how much? ________________


How would you rate your health?
     Excellent              Good         Fair         Poor


                           COMMUNICABLE DISEASES / FAMILY HISTORY


Have you ever had any of the following?
     Measles (Rubella)                   Measles (German)                  Chicken pox


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    Mumps                      Pertussis (whooping cough)               Hypertension
    Scarlet fever              Tuberculosis                      Epilepsy
    Convulsions




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                                  TO BE SIGNED BY A DOCTOR


               This portion of the form must be filled and signed by a physician.


TUBERCULOSIS CONTROL
One of the following:
Chest X-ray            Date _____________     Result __________________________________________
Examination facility ___________________________________________________________________
Skin test              Date _____________     Result __________________________________________
Examination facility ___________________________________________________________________
B.C.G.         Date _____________     Result __________________________________________
Examination facility ___________________________________________________________________


Physician’s Signature _______________________________________________ Date _____________
Physician’s Name (Please print) ________________________________________________________
Address ____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
*Please note that all your immunization shots need to be up to date, including Hepatitis A and B




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                                   ADMISSIONS POLICY


The School of Revival is happy to accept applications at any stage during the year but as a
general rule admission and new student intake will only occur once a year at the beginning
of the fall semester. Due to the nature of this school there will only be spring admissions
on very rare occasions and only at the approval of the Director.


The School of Revival admits students of any race, color, national and ethnic origin to all
the rights, privileges, programs, and activities generally accorded or made available to
students at the school.


Everyone who qualifies within the boundaries of this admission policy is welcomed to apply
with the School of Revival. The policies are as follows:


1. The School of Revival does reserve the right to deny admission to any and all people.
   We do declare, however, that this refusal will not be discriminated based upon age,
   gender, race, nationality, disability, color, creed, academic qualification or
   denominational affiliation.
2. The number of enrollments for any given year will be subject to the capacity of staff,
   facilities and resources available. Any refusal of admission will be based upon one or all
   of these factors due to an inability to meet the instructional and academic needs of
   both the students and the school.
3. All applicants must be over the age of 18 but there is no upper age limit.
4. A person will not be considered for admission if they exhibit ongoing (over a year)
   issues with serious and harmful addictions such as hard drugs, physical abuse, anorexia
   etc. Any person struggling with addictions of a less severe nature will be considered on
   a case-to-case basis.
5. Any person suffering with psychiatric difficulties will be considered on a case-to-case
   basis.


                                   EXEMPTION STATEMENT


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Degree programs of study offered by Catch the Fire | School of Revival have been declared
  exempt from the requirements for licensure under provisions of North Carolina General
  Statutes (G.S.) Section 116-15-(d) for exemption from licensure with respect to religious
education. Exemption from licensure is not based upon any assessment of program quality
                           under established licensing standards.




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              RELEASES, ACKNOWLEDGMENTS AND COMMITMENTS


Applicant Name: _____________________________________________________________________


    Release of Liability
I/We do hereby release Catch the Fire | School of Revival.
It’s staff agents and volunteer assistants from any liability whatsoever arising out of any
injury, damage or loss sustained by said persons during the course of involvement with the
Catch the Fire | School of Revival.


    Consent For Treatment
In case of emergency, I/ We hereby agree to the performance of such treatment,
including anesthesia and surgery, or any other treatment that an attending doctor
or physician may deem necessary. I/We agree to meet any and all medical expenses that
are incurred during the course of involvement with. Catch the Fire | School of Revival.


Applicant Signature: ___________________________________________       Date: ________________


    Financial Responsibility.
I / We understand that the payment of the required school tuition fees must be made in
US funds prior to or upon my arrival. Payment must be made in full for the complete
school year. Further, I agree to meet in a timely manner, prior to the completion of
school, all personal expenses incurred during my involvement with the Catch the Fire |
School of Revival. I/we understand that graduation from the School of Revival is not
granted until all outstanding payments have been received.


    Agreement to abide by School Guidelines & Structure.
If I am accepted I will abide by the rules, commitments and schedules of the school
including:
1. All book reports, assignments, assessments and exams.
2. Arriving at all school functions and commitments on time.

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3. Practical help around the school and church.
4. All training sessions, classes & workshops that are a designated part of my course of
study.
5. Personal development of my gifting and talents as related to my course of study.
6. All ministry & outreach opportunities I am required to participate in.


Applicant Signature: ____________________________________________       Date: ________________


I certify that all the information in this application is complete and accurate.


Applicant Signature: ____________________________________________       Date: _______________




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                                         LIFE HISTORY


Please answer the following questions in a clear printing style or typed using your
computer. Please do not write. Answer as completely as possible.


1. Spiritual growth
   a. Outline your conversion and the events and steps leading up to that time.
   b. Describe your spiritual growth since that time. Comment on events or spiritual
     experiences in your life, which led to new levels of understanding and commitment.
     Include the character issues that God has dealt with in your life and what lessons they
     taught you.
   c. Comment on your devotional life. Include such issues as prayer, Bible reading, Bible
     study, worship, devotions with spouse and family. Are you meeting your expectations
     for personal spiritual growth?


2. Relationships and experience
   d. Please describe your relationship with your local church. Comment on areas of
     ministry, service, leadership experience, gifts and abilities.
   e. Please take one full page each to describe your relationship with your mother and
     your father.
   f. Briefly describe your relationship with the rest of your family.
   g. How does your family feel about your intentions to attend the School of Revival?
   h. What languages do you speak and how proficiently?


3. Goals and expectations
   i. Comment briefly on the circumstances that led up to your decision to apply for this
     school.
   j. What are your reasons for wanting to attend this school? Please include spiritual and
     ministry goals, missionary and church service goals, which you hope the school will
     help you fulfill.
   k. Briefly, what are your plans following the school?

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4. God's work
  l. How do you know that the Holy Spirit is working in your life?
  m. Have you ever experienced a miracle in your life? Please describe it.
  n. What do you think your spiritual gifts are? Do you have the opportunity to exercise
    these gifts in your local church body?
  o. How has the recent move of God impacted your life?




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We realize that the following questions are very personal. Please be assured that all
answers are held in strict confidentiality and are not the basis of your acceptance to the
school. If you have difficulty communicating your answer in writing, Duncan and Kate
Smith can talk with you personally.


Please answer in detail. One sentence is not sufficient.


1. Have you used any of the following substances? If so, please explain how recently, in
   what quantities and what ministry you have had to overcome any addictions:
   a. alcoholic beverages,
   b. tobacco,
   c. "soft drugs" (e.g. marijuana)
   d. "hard drugs" (cocaine, heroin, chemicals).


2. Have you ever had psychiatric treatment? If so, please describe the treatment received,
   dates, any lingering difficulties.


3. Have you ever been involved in any of the following areas? If so, please explain the
   circumstances briefly, the time and length of involvement and what ministry you have
   had to overcome them:
   a. the occult;
   b. a cult or sect, (new age, eastern mysticism, naturalistic philosophies Mormonism,
      Jehovah’s Witnesses, etc.);
   c. heterosexual sin, including pornography and promiscuity;
   d. homosexual activity;
   e. compulsive behaviors, (shopping, eating, washing, scratching, etc.);


4. Do you have a history of abuse? Either verbal, physical, emotional or sexual.


                               WORK HISTORY and EXPERIENCE




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1. Please include a resume or history of your work experience.
2. Please include your involvement in special interest courses, musical abilities, artistic
   talents and hobbies.
3. Please include an official Police Check (normally available at a nominal fee from your
   local police station). A police record will not automatically disqualify you from attending
   the School of Revival. The ministries visited during outreach sometimes require police
   checks.




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                                     REFERENCE FORMS


We require
2 Friend / Co-Worker references
1 Pastoral reference


Your application will NOT be processed until we receive all your reference forms. Please
ensure that all your references complete and send them into our office as soon as possible.


                                 References - Friend / Co-worker


Please list the people to whom you gave your reference forms.
Name ______________________________________________________________________________
Address ____________________________________________________________________________
Phone _____________________________________________________________________________


Name ______________________________________________________________________________
Address ____________________________________________________________________________
Phone _____________________________________________________________________________


                                       Pastoral Reference


Enclosed is a reference form and letter for you to give to your pastor. We want to invite
his/her counsel and input with regards to your application.


Home Church _______________________________________________________________________
Denomination _______________________________________________________________________
Pastor's Name ______________________________________________________________________
Address ____________________________________________________________________________
Phone (______) ______-________            E-Mail __________________________________________
Is your church part of “Partners in Harvest” or "Friends in Harvest"?


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(You may have to ask your pastor.)                    Yes           No
Is your Pastor in agreement with your plans?                 Yes           No
How long have you attended this church? _______________________________________________
What size is the church? ______________________________________________________________
How would you describe your relationship with your pastor?
____________________________________________________________________________________




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FRIEND / CO-WORKER Reference Form (Confidential)               E-Mail: skrueger@ctfraleigh.com


Name of Applicant ___________________________________________________________________
The above applicant has applied to attend a leadership training program with the Catch
the Fire | School of Revival.


We would appreciate it if you would supply the information requested on this form, in
order to aid us in evaluating the applicant's suitability for admission.


Your name __________________________________________________________________________
Address ____________________________________________________________________________
Phone _________________     Occupation _________________________________________________


1. What is your relationship to the applicant, (leader, friend)?
   _________________________________________________________________________________
2. How many years have you known the applicant?
   _________________________________________________________________________________
3. What do you perceive to be the applicant's best qualities?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _____________________________________________________
4. What do you perceive to be the applicant's greatest weakness(es)?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________
5. How do you think the School of Revival will aid the applicant’s development?


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   _______________________________________________________________________________________________
   ___________________________________________________________________
6. What ministry or spiritual gifts have you observed in operation in the applicant?
   _______________________________________________________________________________________________
   ___________________________________________________________________
7. Have you any reservations about the applicant attending the School of Revival?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _____________________________________________________
8. Do you know of any incidents or examples in which the applicant compromised his or
   her Christian faith or moral integrity? If so, please explain, including how it was
   resolved.
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   ____________________________________________________________________________________________


Please rate the applicant's ability to get along with his or her peers:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's ability to relate to authority:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's ability to relate to unbelievers:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's leadership skills:
           Outstanding            Excellent                   Good                Fair
Poor


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Please rate the applicant's ability to overcome adversity:
           Outstanding          Excellent                    Good               Fair
Poor


Signature: _____________________________________________________        Date: _______________




                                   Please direct all forms to:
                                       School of Revival
                                     Catch the Fire Center
                                      9225 Leesville Road
                                    Raleigh, NC 27613 USA




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FRIEND / CO-WORKER Reference Form (Confidential)               E-Mail: skrueger@ctfraleigh.com


Name of Applicant ___________________________________________________________________
The above applicant has applied to attend a leadership training program with the Catch
the Fire | School of Revival.


We would appreciate it if you would supply the information requested on this form, in
order to aid us in evaluating the applicant's suitability for admission.


Your name __________________________________________________________________________
Address ____________________________________________________________________________
Phone _________________     Occupation _________________________________________________


9. What is your relationship to the applicant, (leader, friend)?
   _________________________________________________________________________________
10. How many years have you known the applicant?
   _________________________________________________________________________________
11. What do you perceive to be the applicant's best qualities?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _____________________________________________________
12. What do you perceive to be the applicant's greatest weakness(es)?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________
13. How do you think the School of Revival will aid the applicant’s development?


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   _______________________________________________________________________________________________
   ___________________________________________________________________
14. What ministry or spiritual gifts have you observed in operation in the applicant?
   _______________________________________________________________________________________________
   ___________________________________________________________________
15. Have you any reservations about the applicant attending the School of Revival?
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _____________________________________________________
16. Do you know of any incidents or examples in which the applicant compromised his or
   her Christian faith or moral integrity? If so, please explain, including how it was
   resolved.
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   _______________________________________________________________________________________________
   ____________________________________________________________________________________________


Please rate the applicant's ability to get along with his or her peers:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's ability to relate to authority:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's ability to relate to unbelievers:
           Outstanding            Excellent                   Good                Fair
Poor
Please rate the applicant's leadership skills:
           Outstanding            Excellent                   Good                Fair
Poor


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Please rate the applicant's ability to overcome adversity:
           Outstanding          Excellent                    Good               Fair
Poor


Signature: _____________________________________________________        Date: _______________




                                   Please direct all forms to:
                                       School of Revival
                                     Catch the Fire Center
                                      9225 Leesville Road
                                    Raleigh, NC 27613 USA




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                                      LETTER TO PASTOR


Dear Pastor,


Greetings from Catch the Fire | School of Revival. You have been given this form, by
somebody whom you have pastoral oversight for, who wishes to attend one of our
programs.


The School of Revival is a dynamic leadership training program. It is designed for people
who are already attaining, or heading toward a level of maturity and Godly character. Our
vision is to see people minister with a pure heart, knowing how to sense and flow with the
Holy Spirit, and having the tools to effectively impart the love and power of God.
Obviously personal healing is foundational to a leader’s growth in the Kingdom.


In this way, the students attain a measure of healing in their personal lives but please bear
in mind that the healing is part of their training and is not the primary focus of the school.


We would be grateful if you would complete the attached reference form; so, we can
assess if this school is right for the applicant. If you are unfamiliar with the School of
Revival, please visit our website at www.schoolofrevival.com.


All information on this form is confidential.


We are looking forward to hearing from you.


In the Fathers Love,



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            Catch the Fire | School of Revival is part of Catch the Fire | College


Duncan and Kate Smith
Vice Presidents of Catch the Fire | World
Senior Leaders of Catch the Fire | Raleigh




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PASTOR’S Reference Form (Confidential)                          E-Mail: skrueger@ctfraleigh.com


Name of Applicant ___________________________________________________________________


We would appreciate it if you would supply the information requested on this form, in
order to aid us in evaluating the applicant's suitability for admission.


Your name __________________________________________________________________________
Home Church _______________________________________________________________________
Denomination _______________________________________________________________________
Address ____________________________________________________________________________
Phone _________________      E-Mail ______________________________________________________


1. How long have you known the applicant? ___ Month(s)                  ___ Year(s)
2. What is your position in the church?
           Pastor                Elder                Other _________________________________
3. How well do you know the applicant?
           Very well                     Well                Casually
4. Were you aware of the applicant's intention to participate in this training program prior
   to receiving this form?
           Yes                   No (comments) ___________________________________________
   _________________________________________________________________________________
5. Are you happy with his/her intentions?
   _________________________________________________________________________________
6. In what activities has the applicant participated since attending your church?
   _______________________________________________________________________________________________
   ___________________________________________________________________
7. Has he/she shown effectiveness in these activities?
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   _______________________________________________________________________________________________
   ___________________________________________________________________
8. Does the applicant tithe regularly to the church?
           Yes                  No                   Unsure
9. Upon your observation, do you see the applicant as financially responsible?
           Yes                  No                          Unsure
10. In your association with the applicant, what has been the level of commitment you have
   seen?
           Faithful             Inconsistent         Other (comments) ______________________
   _______________________________________________________________________________________________
   ___________________________________________________________________




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11. This is an evaluation of the applicant's overall characteristics.


Please tick one for each category.


Responsiveness to others                      Leadership Ability
    slow to sense how others feel                  leads naturally
    unusually sensitive and understanding          tries but lacks ability
    reasonably responsive                          has some leadership promise
    understanding and thoughtful                   makes no effort to lead
Physical Condition                            Willingness to serve
    excellent health                               eager to serve as needed
    average health                                 co-operative when asked
    frequently ill                                 reluctant to serve
Intelligence                                  Teamwork
    excellent intellectual capacity                works well with others
    average mental ability                         reasonably cooperative
    learns and thinks slowly                       insists on having own way Relationships


Relationships                                 Achievement
    sought out by others                           takes initiative
    liked by others                                meets average expectation
    tolerated by others                            starts but does not finish
Christian experience                          Ability to follow
    mild but genuine                               appropriately submissive
    relatively superficial                         follows blindly
    rich and growing                               cooperative
    over emotional                                 resistant to direction


12. How does the applicant usually react to trying situations?
        withdraws                        gets discouraged                    gets angry


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          meets constructively                 accepts patiently                  other (explain)
______________
    _________________________________________________________________________________
13. Evaluation of applicant’s emotional maturity.
          Outstandingly mature. Has a proven ability to operate under stress and pressure.
          More mature and emotionally stable than average.
          Possesses adequate emotional stability and maturity.
          Doubtful. Experience has shown that the applicant might not be able to handle
trials.
    Additional Comments:
    _______________________________________________________________________________________________
    _______________________________________________________________________________________________
    _______________________________________________________________________________________________
    _______________________________________________________________________________________________
    _______________________________________________________________________________________________
    ___________


14. Please comment on areas of weakness you might be aware of.
    _______________________________________________________________________________________________
    _______________________________________________________________________________________________
    _____________________________________________________
15. To your knowledge, has the applicant ever been arrested for any offense?
             Yes          No       If yes, please explain: ___________________________________
    _________________________________________________________________________________
16. Has the applicant proven on any occasion to be unreliable, dishonest, or of
    questionable character?
             Yes          No       If yes, please explain: ___________________________________
    _________________________________________________________________________________
17. To your knowledge, has the applicant been involved in any of these areas?
    Drug and alcohol abuse, homosexuality, extramarital or premarital sexual relationships,
    pornography, the occult, and compulsive behaviors.


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             Yes            No       (If yes, on a separate sheet of paper, please comment
briefly on what he/she has done to resolve the issue and find restoration.)
             Please check here if you feel that you cannot answer this question in writing, we
would be happy to speak with you personally. All answers are confidential.
18. Please comment on the family background.
   _________________________________________________________________________________
19. Overall, what do you consider to be the applicant’s strong points? (include special
   abilities)
   _______________________________________________________________________________________________
   ___________________________________________________________________
20. What changes have you noticed in the applicant's life during this current move of the
   Spirit?
   _______________________________________________________________________________________________
   ___________________________________________________________________
21. What could the Catch the Fire | School of Revival do to aid the applicant's
   development?
   _______________________________________________________________________________________________
   ___________________________________________________________________
22. Do you recommend this person for admission to this training program?
   _________________________________________________________________________________


To the best of my knowledge the above information is correct and I believe that he/she
possesses the qualities indicated above.


Signature: _____________________________________________________           Date: _______________


Thank you for your time and help with this application.




                                     Please direct all forms to:
                                          School of Revival


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            Catch the Fire | School of Revival is part of Catch the Fire | College


                                   Catch the Fire Center
                                    9225 Leesville Road
                                  Raleigh, NC 27613 USA




Student Application                                                             Page 33 of 33

								
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