ECHO ELN School of Ministry NorthRock Church Thornton, CO

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1 Student Application ECHO ELN School of Ministry NorthRock Church Thornton, CO 1. Name: (last) _ (first) 2. Home Address: (street) (city) (state) (zip) 3. Phone Numbers: (home) ( ) (cell) ( ) Current Age: 6. Birthday: _/_/_ 7. Driver s License Number (a valid driver s license is required for the duration of ELN): # State in which License was Issued: 8. Social Security Number: # 9. Passport Number (a valid passport is required for the duration of our ELN program): # _ 10. Father s / Guardian s Name: 11. Mother s / Guardian s Name: 12. Of what country are you a citizen? 13. Church Name: City& State: Phone: ( ) Pastor s Name: 14. Which of the following areas of ministry do you enjoy or find that you have gifting? (Please check all that apply.) Speaking Dance Children s work Medical Teaching Evangelism Youth work Computers Music Counseling Prayer Secretarial Worship Administration Electrical Graphics Art Encourager Plumbing Video Drama Hospitality Carpentry Other:

2 Educational and Academic History Note: a minimum of a GED is required prior to admittance into ECHO ELN. 15. Year of your high school graduation: 16. How many years of college will you have completed prior to entering ELN? _ 17. Describe your academic strengths and weaknesses: Personal History 18. When did you receive Jesus Christ as your personal savior? 19. Briefly describe your lifestyle before your salvation: 20. Have you been baptized in water? If so, when? 21. Have you been baptized with the Holy Spirit? If so, when? 22. Please write the story of how you met Jesus in one hundred words or less: _ 23. List your reasons for wanting to join ECHO ELN: 24. What calling do you believe God has placed upon your life (schooling, ministry, occupation, etc.)? _

3 25. How do your parents/guardians feel about you joining ECHO ELN? 26. How many brothers and sisters do you have? 27. Describe your involvement at your church (ministry, assistance, teaching, ushering, attendance, etc.): 28. Are you planning on participating in ECHO ELN for one or two years? 29. In which Ministry Track are you planning on participating? 30. What are your plans after ECHO ELN? 31. Please describe your devotional life (time devoted to prayer and Bible reading) over the past three months: 32. Please describe any conditions you have (or have had in the past two years) that affect your relationships, ability to study, or other areas of life (depression, anxiety attacks, attention deficit disorder, etc.): 33. Will it be difficult for you to respond to the authority of the ECHO ELN staff, NorthRock staff or your Host-Parents?

4 Uniform Information Men: Neck Size (in inches): Arm Length (in inches): T-shirt size: Women: Dress Shirt Size: T-shirt size: Financial Information Please indicate how you are planning to pay for your involvement in ECHO ELN: Student Agreement I have read the current ECHO ELN Student Handbook, and I agree to fully comply with all program rules, guidelines and policies, including those related to dismissal, romantic relationships, living with a Host-Family, and my personal financial commitment to ECHO ELN. I understand that my compliance with these rules, guidelines and policies applies to me during the entire time I am an ECHO ELN student, including weekends, scheduled breaks, times of travel, and missions trips. (circle one) YES / NO All information provided in this Application is complete and accurate. I realize that supplying incomplete or false information in this Application, or during my interview with ECHO ELN staff, may result in my failure to be accepted into ELN, or may result in being dismissed from the program. I consent to the sharing of information written on this Application, as well as the information I will share during my Application Interview, with the staff of ECHO ELN, the church staff, and with the Host-Parents with whom I might be placed. Applicant s Signature Date Submission of Application Applications must be postmarked six weeks prior to the program start date of ECHO ELN. Any faxed copies must be followed up immediately by mailing the original Application. Please send your completed Application to: ECHO ELN School of Ministry Grant St. Thornton, CO 80229

5 Section for Foreign Students A valid visa and passport from is required for the duration of ECHO ELN. You must bring the papers associated with your visa and your passport with you to ECHO ELN. Please contact us for a separate guide to help you attain the proper clearance for your participation in ECHO ELN. a. Type of Visa: b. Dates Visa is Effective: c. Type of Passport: d. Dates Passport is Valid: _ e. Will your Visa need to be renewed during your time in ECHO ELN? f. Will your Passport need to be renewed during your time in ECHO ELN? g. LIN Number: # h. Name of U.S. Consulate or Embassy, which issued your Visa, and the name of city and country in which it is located: _ Application Checklist Non-refundable $50 application fee, made out to NorthRock Church (fee is waived if application is post-marked at least six-months prior to start date) Completed application One confidential references from Christian friends One confidential reference from a Pastor Recent photograph (graduation or passport style) Completed health care information form Photocopy of current immunization record Photocopy of current driver s license and proof of insurance Completed an interview with ECHO ELN Staff Criminal background check (to be completed at time of interview) For Minor Applicants Only (students who will be minors at the start date of the program) Parent/guardian waiver and release (this form must be requested from ECHO ELN)

6 ECHO ELN Health Care Information Please fill out the following information as thoroughly and accurately as possible: Student s Last Name First Middle Insurance Company Date of Birth Age Policy Number Address Father s Name City State Zip Father s Business Location Home Phone Allergies (drugs or food) Medications you are currently taking Last Tetanus Immunization Family Physician In case of emergency, contact: Father s Business Phone Mother s Name Mother s Business Location Mother s Business Phone Physician s Phone Number Emergency Contact Phone Number Please list any physical conditions you have that require a doctor s supervision: Please list any physical conditions that you have that occasionally are bothersome to you (back problems, allergies, headaches, etc ). In case of minor medical emergency, I would like to go to the following doctor or medical clinic: Clinic Address Clinic Phone Number ( ) Dates of Childhood Immunization Hepatitis A: Smallpox: Polio: TB Test: DTP: MMR: B: For Students Not Living at Home Please send a copy of your current immunization records: Yes, I ve enclosed them

7 Student s Signature Date Friend s Confidential Reference ECHO ELN School of Ministry NorthRock Church Thornton, CO Applicant s Name: _ Phone Number: ( ) The individual named above has applied to become a student in the ECHO ELN school of ministry. ECHO ELN is a ten-month, intense, church-based, leadership training school for young adults who desire to grow in their knowledge of the Bible and in their ability to minister effectively. Serious consideration will be given to your comments, so carefully and quickly complete this form and return it directly to ELN. Your comments will be held in confidence. Any additional comments may be made on a separate sheet of paper and attached to this reference. Applicant s Instructions: This form is to be filled out by a Christian friend and mailed directly to ECHO ELN. Family members may not fill out this form. 1. Please check the box that best describes the applicant: Mental ability Personal motivation Maturity Appearance Church attendance / involvement Spiritual growth observed Self-image Emotional stability Coping with personal problems Response to pressure Financial responsibility Honesty Openness / transparency Moral standards Positive attitude Judgment / common sense Creativity Adaptability / flexibility Teamwork / cooperation Excellent Good Fair Poor No Observation

8 Servanthood Follows instructions Teachable Liked by others Concern for others Communication skills Leadership ability Self-discipline Physical condition of health 2. In your opinion, this applicant s Christian witness is which of the following: Mature Contagious Genuine and growing Over-emotional Superficial Other: 3. Please comment on areas of strength or weakness in the character of the applicant? 4. What specific gifts or abilities do you recognize in this applicant? 5. Does this applicant have any persistent problems or habits that might restrict him/her from fitting into an intense and challenging program? If so, please describe. 6. To your knowledge, during the past six-months has the applicant engaged in behaviors that are inconsistent with the life of a believer (drunkenness, drug use, sexual activity, viewing pornography, lying, cheating, etc.)? If yes, please describe: 7. Would you recommend this applicant for acceptance into ELN? Yes No With hesitation 8. How many years have you known the applicant? _ years. How close do you consider your relationship to be? Very close Fairly close An acquaintance Minimal

9 Applicant s Name Referent s Name Address City State Zip Phone ( ) Referent s Home Church Position in Church (if applicable) Signature Date Please mail to: ECHO ELN Phone: (303) Grant St Fax: (303) Thornton, CO echo@northrockchurch.com

10 Pastoral Confidential Reference ECHO ELN School of Ministry NorthRock Church Thornton, CO Applicant s Instructions: This reference should be completed by your pastor and mailed directly to ECHO ELN. If your father or mother is your pastor, please give this form to the assistant pastor or youth pastor in your church who knows you best. If a person other than your pastor (assistant pastor or youth pastor) completes the form, an explanation should be provided. Pastor s Instructions: The applicant named below has applied to become a student in the ECHO ELN school of ministry. The information requested on this form will assist us in evaluating the applicant s ability to succeed in this intense discipleship program. The applicant cannot be considered until all reference forms are received; therefore, your quick completion of this form would be very much appreciated. This reference will be kept in confidence. Thank you for your assistance. Applicant s Name: _ Phone Number: (_) 1. How long have you known the applicant? 2. How long has the applicant attended your church? _ 3. How well do you know the applicant? Very well Fairly well Casually By name/sight 4. How would you describe the level of commitment shown by the applicant? Highly committed Somewhat committed Low level of commitment 5. Evaluation of applicant s emotional maturity (please check one): Outstandingly mature. Has demonstrated an ability to function effectively under stress. More mature and emotionally stable than average. Possesses adequate emotional stability and maturity. Has demonstrated some inability to function effectively under stress. Has frequently demonstrated signs of inability to cope with stress, such as anger or withdrawal. 6. How does the applicant usually react in stressful, difficult situations (check all that apply)? Withdraws Gets discouraged Gets angry Accepts patiently Acts constructively Seeks assistance from leaders 7. Has applicant proven on any occasion to be unreliable, dishonest, or of questionable character? No Yes If yes, please explain: 8. As far as you know, has the applicant ever been arrested for any offense? No Yes If yes, please explain:

11 9. Please check the box that best describes the applicant: Mental ability Personal motivation Maturity Appearance Church attendance / involvement Spiritual growth observed Self-image Emotional stability Coping with personal problems Response to pressure Financial responsibility Honesty Openness / transparency Moral standards Positive attitude Judgment / common sense Creativity Adaptability / flexibility Teamwork / cooperation Servanthood Follows instructions Teachable Liked by others Concern for others Communication skills Leadership ability Self-discipline Physical condition of health Excellent Good Fair Poor No Observation 10. In your opinion, in which of the following areas of ministry does the applicant seem gifted? Speaking Dance Children s work Medical Teaching Evangelism Youth work Computers Music Counseling Prayer Secretarial Worship Administration Electrical Graphics Art Encourager Plumbing Video Drama Hospitality Carpentry Other:

12 11. If you were to consider this applicant for an intense, fast-paced and challenging discipleship program, would you feel that this applicant has the capacity and potential to succeed? Yes No If no, please explain: 12. To your knowledge, during the past six-months has the applicant engaged in behaviors that are inconsistent with the life of a believer (drunkenness, drug use, sexual activity, viewing pornography, lying, cheating, etc.)? If yes, please describe: 13. Do you recommend the applicant for acceptance as a student of the ECHO ELN school of ministry? Yes No With hesitation 14. If you would like to share any additional information, please attach a separate sheet with this reference, or indicate below that you would like a phone call to discuss this reference further. Would you like a call to discuss this applicant further? Yes No Name of Pastoral Referent Address City State Zip Phone ( ) Church & Denomination Position in church (if applicable) Signature Date Please mail to: ECHO ELN Phone: (303) Grant St Fax: (303) Thornton, CO echo@northrockchurch.com Check here if you would like us to send you more information about the ELN School of Ministry. Yes, please send more information!

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