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Last updated on May 27th, 2010
GPMC Application
Full Name
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Present Address
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City
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State
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ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
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ORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
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Zip Code
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Home phone number
Best time to call
Personal
Sex:
Email Address
email required
Phone Number
Cell Phone
Birth Date Month
January
February
March
April
May
June
July
August
September
October
November
December
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Day
1
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22
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27
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31
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Year
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Gender
Male
Female
Social Security Number
Are you a US citizen?
Yes
No
Are you a resident alien?
Yes
No
Birthplace
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Tee Shirt Size
Small
Medium
Large
X-Large
2X-Large
3X-Large
Sweat Shirt Size
Small
Medium
Large
X-Large
2X-Large
3X-Large
Educational History
Highschool
Dates Attended
Did you graduate?
Yes
No
College
Dates Attended
Course of Study
Other Education
Family Information
Marital Status
Single
Married
Divorced
Name of Spouse
Children
Yes
No
Name of Father or Guardian
Address
State
select one
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
ORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Phone Number
Has he accepted Christ?
Yes
No
Occupation
Church
Name of Mother or Guardian
Address
City
State
select one
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
ORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Phone Number
Has she accepted Christ?
Yes
No
Occupation
Church
Health Information
How would you describe your health?
Excellent
Good
Fair
Poor
List any allergies
List any medications you are currently using
Please describe any physical limitations, mental illness and/or emotional conditions, and state any special attention or treatment required
Has your education/employment been disrupted for any period of time because of a physical or nervous disorder?
Yes
No
Master?s Commission History
Are you currently, or have you been a student or a staff member at another Master?s Commission?
Yes
No
If yes, which program?
What year(s) have you completed?
Will your director give you a positive recommendation?
Yes
No
Personal History
Please answer the following questions honestly. It is important that we understand any issues you may face while in the program, in order that we may serve you best. Answering yes to any of the following does not necessarily disqualify you from admission to GPMC. Please attach any additional information about yourself that you feel would be beneficial to us.
Have you used or are you currently using illegal drugs?
Yes
No
If yes, date of last use:
Have you ever misused or abused a legal drug (over the counter or prescription)?
Yes
No
If yes, date of last use:
Do you currently smoke?
Yes
No
Do you drink alcoholic beverages?
Yes
No
If yes, date of last use:
Have you ever been arrested?
Yes
No
If yes, when:
Were you convicted?
Yes
No
Have you ever been involved in homosexuality/lesbianism?
Yes
No
How long since last involved?
Are you a sex offender?
Yes
No
If yes, are you registered?
Yes
No
Do you have any eating disorders?
Yes
No
If yes, have you sought treatment?
Yes
No
Do you have an addiction to pornography?
Yes
No
Have you ever intentionally injured yourself? (i.e. cutting, burning)
Yes
No
How long since last incident?
Are you prone to violent behavior?
Yes
No
Are you a dishonest individual?
Yes
No
Financial Information
Will you have the total amount by the required date?
Yes
No
If no, please explain.
Do you have your own vehicle?
Yes
No
(we prefer that students have their own transportation; gas money and car repairs are the sole responsibility of the student)
Do you have auto insurance?
Yes
No
(students will not be allowed to drive during their time at GPMC unless they have auto insurance)
List any debts, loans, or payments that you currently have
Will your debts be paid off by the start of MC?
Yes
No
If no, how will you make payments?
Do you have health insurance?
Yes
No
(students will be required to pay for any medical attention needed during their time at GPMC)
Church History
Name of home church
Denomination
Address
City
State
select one
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
ORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Phone Number
How long have you attended?
Do you attend regularly?
Yes
No
Are you a member?
Yes
No
Senior Pastor
Youth Pastor
When did you accept Christ?
Required info
Have you been baptized in water?
Yes
No
Have you had an Acts 2:4 experience? (not required for acceptance)
Yes
No
Are your parents/guardians supportive of you coming to MC?
Yes
No
If no, please explain why:
References: (Name, Relation, Phone Number)
Reference 1
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Phone:
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Reference 2
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Phone:
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Reference 3
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Phone:
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