| Ministry Training Center

Full Name*

First Name Last Name

Email (personal)*

Phone Number*

Address*

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

Date of Birth*

Gender*

Please attach a picture of yourself

Occupation*

Highest level of education completed*

Membership: Church name*

Conference/Affiliation*

Marital Status*

Spouse

First Name Last Name

Reference Form: Parents

PARENTS*

Names Last Name

Email (Parents)*

Enter Email Confirm Email

Important: make sure email is correct. Reference form is automatically sent to this address.

Phone Number*

Reference Form: Pastor

PASTOR*

First Name Last Name

Email (Pastor)*

Enter Email Confirm Email

Important: make sure email is correct. Reference form is automatically sent to this address.

Phone Number*

Reference Form: Youth Pastor

YOUTH PASTOR (required when available)

First Name Last Name

Email (youth pastor)

Enter Email Confirm Email

Important: make sure email is correct. Reference form is automatically sent to this address.

Phone Number

Reference Form: Employer

EMPLOYER (required when available)

First Name Last Name

Email

Enter Email Confirm Email

Important: make sure email is correct. Reference form is automatically sent to this address.

Phone Number

Reference Form: Friend

FRIEND*

First Name Last Name

Email (friend)*

Enter Email Confirm Email

Phone Number*

NOTES:

1. Only click "Submit Form" once. Submission may take a few minutes depending on the file size of your profile picture.

2. When you click "Submit Form", a reference form will automatically be emailed to the references you listed above. Please ensure that the email addresses you provided are correct and current.

3. After clicking "Submit Form", you will be directed to
Step 2: Childcare Application.

If you have questions or technical difficulties, feel free to call Jesse Slabaugh at 717-715-2030.

Record Type Childcare (Hidden Field)

Application Status