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Marital Status *

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Sex: *

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Date of Birth *

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I have accepted Jesus as my Lord and Savior. *

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Education *

Check all that apply.

High School

GED

Some College

4 Year Degree +

Other

I agree to the national background check *

Because of our proximity and interaction to the Lake Retreat Camp and the minors that are regularly on campus, we require that all students pass a national background check.

Conditions of Enrollment *

1. Students are expected to participate in every element of the weekly schedule. Punctuality and cooperation are essential for the well being of the student body and for personal discipline. Students who miss class or work for reasons other than sickness or extenuating circumstances will not complete the program. 2. All students attend the same classes. There will be a different teacher and topic each week. Homework includes a weekly response paper and Bible reading, along with assignments from teachers. 3. The use of all forms of alcoholic beverages, tobacco, and recreational drugs is not allowed while enrolled as a student. 4. Students are not allowed to bring firearms to school. Pets are not allowed on campus. 5. A major part of discipleship is hard work. In order to cover the cost of the program, each student will participate in daily and weekly work projects and shifts. Term #3 will focus extensively on work as discipleship. A teachable heart, good attitude and hard work will be essential for all students. 6. Additional rules and guidelines will be in effect during the school term. These are fully explained and presented in the Student Handbook, which the student will receive during student orientation. 7. All students must pass a state and national background check in order to participate in the program because of the nature of the campus and its proximity to minors.

Are you applying to other schools? *

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If yes, which schools?

How did you hear about us? *

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I am familiar with Lake Retreat Camp

Other

If referred, who referred you?

What is your purpose for attending Adelphia? *

For this section, it is easiest to write your short answer in a Word document and then paste into the box.

Describe your relationship with God: *

When/how did you surrender your life to Jesus' authority? *

How have you shown yourself to be teachable and eager to learn? *

Are you willing to be stretched for the sake of your spiritual and personal growth? *

Church Currently Attending *

Fine Print: *

 I understand that by submitting this form, Adelphia Discipleship School will be contacting me by email, text and phone. Submitting this form also constitutes my express written consent to receive phone calls and text messages from Adelphia Discipleship School, at the phone number(s) I have provided, including a wireless number. I also understand that consent is not a condition of enrollment. NOTE: Enrollment does not mean or imply acceptance into Adelphia Discipleship School.

I agree - Reference Section *

I agree and consent that the references given here will be used to help Adelphia Discipleship School staff assess readiness and fit for this program. I give consent for them to talk freely to the Adelphia Staff in regards to this reference.

1. Pastoral Reference: Name *

1. Pastoral Reference: Email *

1. Pastoral Reference: Phone Number *

2. Personal Reference: Name *

2. Personal Reference: Email *

2. Personal Reference: Phone *