LTIA Student Profile
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Email
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Home Phone
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| Cell Phone
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| Date of Birth
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| Age
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| Social Security Number
| This is used to gain security clearances only to visit the White House, etc. when available.
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| School
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| School type
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| Grade Average
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| Previous Leadership / Ministry Training
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| Are you a Christian?
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| Yes No I am not sure
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| Name of parent(s) or guardian(s)
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| Church you currently attend
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| Pastor's Name
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| Pastor's Phone Number
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| Pastor's Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Why do you want to attend LTIA?
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| List honors and awards you have received.
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| Briefly explain your testimony of salvation:
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| Student Covenant
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| I agree and will abide by the student covenant. I do not agree with the student covenant. Those who love God, love His rules and live by His Word! Therefore,
I will maintain the highest moral standards worthy of Christ and present a personal witness of leadership in godliness through proper conduct and modest dress.
I will not drink alcoholic beverages, smoke, or use any type of illegal drug or offensive language because the Bible says that Christians should “think on things that are excellent” and “avoid all appearance of evil.”
I will respect my teachers and my peers by being prompt and attentive in all classes and activities, and I will respect the property, privacy, and rights of others, including those of others not associated with LTIA.
I will encourage other LTIA students to live for God also. I will not bring to LTIA anything that would detract from this goal, including radios, boom boxes, TVs, walkmans, music, or inappropriate literature, and I will keep myself, my belongings, and my room neat and clean.
Above all, I will honor Christ by obeying the rules and submitting to the authority of the LTIA staff so that I can reap the greatest possible benefit from the training, and experience the greatest time of my life!
I understand that I will be warned and asked to leave the conference if I fail to abide by the conditions of this signed covenant.
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| Liability Clause
| I agree to assume the risk of liabilty for my self/ my child's participation. I understand that activities at LTIA are organized and safe. In the event of mishap, however, and as a condition of my own and/or my child’s participation, I agree to assume the risk for any injuries and damages that I and/or my child may suffer which result from LTIA activities, and release LTIA, its employees, staff, and agents from liability.
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| Student sight-seeing
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| Please select the minimum number of students you approve of: I give permission to LTIA to allow my child limited, unsupervised free time (individually, in a group of 2 , 3, 4 ) or more students to tour sights in Washington D.C.
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| Photos and Videos
| I give my permission to allow LTIA to publish photos and videos, which may include me, on the web.
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| Parent/Guardian Initials
| My child is under eighteen, and I have read and agree with the above. I approve of the rules and Leadership Training Institute of America’s endeavor to provide the best possible learning environment for my child. I have read my child's application and am in agreement with the information contained therein.
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| Emergency Contact
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| Prefix
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| First
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| Last
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| Suffix
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| Emergency Contact Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Parent/Guardian Cell Phone
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Other information
Please note that a signed medical release by the student (or parent/guardian if the student is under 18) must be submitted, and cannot be done electronically. The medical release will be provided to you after this profile is complete.
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Image Verification
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EMF HTML Contact Form
EMF HTML Contact Form