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RESIDENCY APPLICATION

Hola!

We are so excited that you are applying to our residency program!

We know that applying for this program can be intimidating for many reasons but don't worry, we are here to help you as you take your next step. Our application shouldn’t be complicated or burdensome. We just want to be sure our residency program will be a healthy experience for you. We want our program to be full of growth for you personally and for the people on your team.

As you apply, we want you to know that any lack of ministry experience, or that your challenges / struggles do not disqualify you from becoming a resident with us.

We are thrilled to get to know you!

Your Full Name *
Your Full Name
Address *
Address
Tell us about your family and about your experiences with school, church, travel, friends, family dynamic etc.
Feel free to share your testimony or any faith significant moment.
What is your religious background (denomination)?
REFERENCES
Professional Reference *
Professional Reference
Phone *
Phone
Ministry Reference
Ministry Reference
Phone 1 *
Phone 1
Personal Reference *
Personal Reference
Phone 2 *
Phone 2
Have you ever been arrested or convicted of a crime? *
Were you ever abused in any way? *
Have you been diagnosed with a mental illness ? *
Example: Anxiety, Depression, Bipolar, Schizophrenia, Borderline Personality Disorder, Other
Have you harmed yourself in any way? *
Example: Eating Disorder, Self-harm, Suicidal Thoughts/Attempts, Substance Abuse
Medical History
It is critical that we are aware of medical conditions or medications that may impact your residency. Please answer the questions below thoroughly.
List any major diagnosis in the last 10 years (Include year of diagnosis). List any other conditions we should be aware of.
Please complete all 3 of the following about medications you are currently taking and may be taking while on your residency. List all prescription medications you will bring. List the condition for which each medication is required. List any side effects you experience while taking each medication.
Please list any known allergies that would require medical attention and/or an Epi-Pen. Please list any known allergies that would cause a non-emergent reaction.
Expectations
The desire for our residency program is for you to become more like Jesus and engage with the world as He did. Throughout our time in ministry, we’ve learned a few things. We’ve identified some key factors that will help make your residency a success. We will cover and revise these as you reside with us. We fully believe that these expectations are an integral part of fulling the life and ministry God has for you. Our team will encourage you to follow these expectations and help you as you try to abide by them. Not following these expectations can compromise your experience in our program. Ultimately, we are here to help and champion your participation. We want to help you grow and follow Jesus more closely. Our residency program has a zero tolerance for alcohol, tobacco, and drug policy. During your time ministering with us, you are expected to adhere to our program policy. Should you partake in alcohol or tobacco you will be subject to disciplinary actions, which may include removal from the program.
Expectations Acknoledgement