EmailMe Form - Pacific Leadership Institute Online Application

Please indicate which session you are applying for

Winter/Spring 2017 (Jan 4 - Jun 30 2017)

Fall/Winter 2017/2018 (Sep 4 - Mar 1 2018)

Today's Date

MM / DD / YYYY

Name

First Last

Email Address

Phone (if applying from outside the US, please include country code.)

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Applicant's Date of Birth

MM / DD / YYYY

Citizenship

Marital Status

Name of Spouse

Spouse Date of Birth

MM / DD / YYYY

Please enter the names and ages of any chilcren you have that will accompany you. (In the event we are able to accomodate dependent children.)

Church Name

Church Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Church Web Site

Name of Lead/Senior Pastor

Name of Church Leader you mainly relate to

Education Information:
What is your highest level of completed education? Please list the names of the last two educational institutions/programs and Month/Year of completion. We may ask for extra information later.

Please list any other ministry related training you have gone through and completed. What, Where, When? Please provide the name(s) of program teacher/leader. We may ask for extra information later.

Have you ever been on a short-term missions trip? Please provide information about any that you have taken part of. Please also provide name of leader and contact info. Please tell us about it.

Occupation

Work experience:
Please list your work experience: Employer, position, dates of employment (mm/yy)

Which of our 3 concentrations are you most interested in? (We won't hold you to it!)

Church Planting

Global Missions

Social Justice

Why do you want to attend Pacific Leadership Institute? What do you expect to get out of this school? Also please tell why you indicated the above concentration?

Please list any ministry experience you have, including what giftings you have, as you see it.

Please tell about your Christian walk: How did it begin? How is it now?

How long have you been involved in your current church? In what capacity?

Have you ever been convicted of a crime? If yes, Please explain.

Are you willing to consent for us to perform a background check on you?

Yes

No

Please provide the name and contact info (address, phone number, email) to two "ministry leaders" who would recommend you to our school.

Please provide the name and contact info (address, phone number, email) to an adult who knows you well and can speak about your character.

Please tell what your family thinks about you attending Pacific Leadership Institute? Are they supportive?

How do you plan to pay for the tuition?

Students will need to provide for some local transportation needs. Will you have a vehicle for use while at the school? If not, will you have extra finances to pay cost-sharing for transportation? Recommended amount $40 per month.

Do you have any food allergies? If yes, please list.

Please tell us about yourself; your interests, passions, hobbies, etc. Please tell in a way that we can get an accurate picture of who you are.

Please upload a recent photograph of you.

Applicant Declaration: I have answered these questions to the best of my ability and have been truthful. I understand that I am not guaranteed admission and that the Pacific Leadership Institute reserves the right to request additional information.
Please print your name below as representing your signature.

Further instructions:

Please send an application fee of $40 USD payable to: Pacific Leadership Institute in order to be considered for acceptance. Payment can be made through PayPal. Application fee will be refunded if not accepted, minus a small transfer fee.
APPLICATION FEE WAIVED FOR APPLICATIONS SUBMITTED PRIOR TO JUNE 1 2016