Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Date of Birth
*
MM
DD
YYYY
Facebook Account
Instagram Account
Father/Guardian
*
Father/Guardian Occupation
*
Mother/Guardian
*
Mother/Guardian Occupation
*
Please list the first name of your siblings and their ages and occupation if applicable:
What is your Current GPA? ( ____/4.0)
What is your ACT Score?
Extra Curricular Activity #1
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #2
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #3
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #4
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #5
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #6
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Extra Curricular Activity #7
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Additional Extra Curricular Activities
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #1
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #2
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #3
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #4
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #5
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #6
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #7
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #8
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Community Service Activity #9
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Additional Community Service Activities
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Which Pastor at LaPorte Assembly are you MOST Familiar with?
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Pastor Jeff Hines (Lead Pastor)
Pastor Roger Coleman (Executive Pastor)
Pastor Ken Grace (Youth/Worship Pastor)
Pastor Ryan Jackson (Children's Pastor)
How long have you been attending LaPorte Assembly or one of its ministries?
*
How often do you attend church? (Sunday morning, Bible study, 365, Home Group)
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1 time each month
2 times each month
3 times each month
4 times each month
More than 4 times each month
Christian Service Activity #1
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #2
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #3
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #4
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #5
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #6
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Christian Service Activity #7
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Additional Christian Service Activities
Activity, Year(s), Hours, Sponsor, Sponsor's Phone #, Sponsor's Email
Briefly describe your Salvation experience and if applicable your Baptism in the Holy Spirit.
*
What University/College do you plan to attend?
*
What is your intended Major?
*
What is your planned career goal for that major?
*
How do you expect to finance your college expenses? List the sources as a percent (%).
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Parents, Loans, Scholarships/Grants, Other
Write a 250 word essay explaining your goals and career into which you feel God is leading you.
*
