FIRST NAME _____________________________ LAST NAME ____________________________________
NICKNAMES __________________________________ MIDDLE NAME _____________________________
ADDRESS _______________________________________________________________________________
CITY ________________________________________ STATE ________ ZIP _________________________
PHONE ____________________________ E-
DATE OF BIRTH ______________________ PLACE OF BIRTH ____________________________________
WHERE GREW UP ___________________________________ EDUCATION _________________________
MARRIED SINGLE DIVORCED SEPARATED SPOUSE ________________________________
CHILDREN (AGES) _______________________________________________________________________
FATHER’S NAME ___________________________ LIVING? _____ DIVORCED? _____
MOTHER’S NAME __________________________ LIVING? _____ DIVORCED? _____
IF PARENTS DIVORCED, WHAT AGE WERE YOU THEN? _____
YOUNGER BROTHERS _______ OLDER _______ YOUNGER SISTERS ______ OLDER ______
YOUR OCCUPATION ______________________________________ HOW LONG? _____
GREW UP IN WHAT CHURCH OR DENOMINATION? ____________________________________________
PRESENT CHURCH ATTENDANCE (IF ANY) ___________________________________________________
PASTOR’S NAME _________________________________________
WHEN DID YOU TRULY ENCOUNTER THE LORD? __________________
HAVE YOU?: BEEN WATER BAPTIZED ______ HOLY SPIRIT BAPTIZED ______
DO YOU?: SPEAK/PRAY IN TONGUES ______ KNOW YOUR GIFTINGS ______
WERE YOU BORN OUT OF WEDLOCK? ______ WERE YOU AN UNWANTED CHILD? ______
BRIEFLY DESCRIBE YOU EARLY RELATIONSHIP
WITH YOU FATHER ______________________________________________________________________
WITH YOUR MOTHER ____________________________________________________________________
ANY
OCCULT INVOLVEMENT (EXPLAIN) _____________________________________________________
ON THE BACK SIDE OF THIS SHEET, PLEASE, TELL US WHY YOU BELIEVE YOU NEED MINISTRY
CONFIDENTIAL INFORMATION
Friday, December 23, 2011