ESTHER’S URBAN MISSIONARY ACADEMY

APPLICATION FORM

P.O. Box 8 Clarkston, Georgia 30021

(Please Print)

Today’s Date____________________________

Name________________________________________________________________

DOB:______/_____/________

Marital Status: Single__Married__Divorced__Separated__

Number of children___________ages______________

Home Address______________________________________________________

Home Phone____________________ Work phone_______________________

Cell phone__________________________

E-mail address______________________________________________________

Church______________________________________________________________

Denomination______________________________________________________

Pastor______________________________________________________________

Pastor’s E-mail______________________________________________________

Church Address____________________________________________________

_____________________________________________________________________

Church Phone____________________   Are you a member?___________

Length of membership____ Are you saved?____ How long?_______

Have you been baptized?_____________

What ministry roles or service do you provide at your church?_____________________________________________________________________

_____________________________________________________________________

Do you pay tithes? _____Yes _____no

HS Grad ____    GED ____     Some College ____  College Grad____

How did you find out about EUMA? ____________________________________________________________________

I would say my strongest gifts or abilities lie in the areas of: