Urban Leadership Residency -- Application

Full Name

This address will receive a confirmation email

Personal Background Information

Phone

Phone Type

Mobile Home Work Other

Birthday

Gender

Male Female

Ethnicity

Non Hispanic/White Hispanic or Latino Black or African American Native american or Native Indian Asian/Pacific Islander Other

Marital Status

Single Engaged Married

Are you a US citizen?

Yes No

Have you ever been convicted of a Felony?

Yes No

Please provide your social media usernames/handles:

What is the best way to contact you?

Phone Text Email

Education and Leadership Background

What is the highest level of education you have completed?

Graduate Degree Undergraduate Degree Some College High School Other

What High School did you attend?

High School GPA:

Leadership experience- Describe any leadership roles you have held in the past, whether within a church, community organization, or other context.

Why are you interested in participating in the Urban Leadership Residency program?

Church and Spiritual Background

What Church do you currently attend?

How long have you been attending?

Less than a year 1-2 years 3-5 years 5+ years

Have you committed your life to Jesus?

Yes No

Have you been baptized?

Yes No

Tell us about your faith journey in 300-500 words.

Describe your involvement in your church.

Tell us about your serving/ministry experience.

Pastoral Reference: Include Name, Phone Number, Email address, Church Name and Address.

Employment Background

Please provide detailed information about your relevant employment history.

Current or most Recent Employment:

Job Title

Company Name

Location

Start Date

End Date (if Applicable)

Description of Responsibilities (briefly outline your key responsibilities and achievements in this role.)

Previous Employment:

Job Title

Company Name

Location

Start Date

End Date

Description of Responsibilities (briefly outline your key responsibilities and achievements in this role.)

Previous Employment:

Job Title

Company Name

Location

Start Date

End Date

Description of Responsibilities (briefly outline your key responsibilities and achievements in this role.)

Professional Reference: Include Name, Phone Number, Email address, Church Name and Address.

More About You

What educational program are you applying for?

Bridge Initiative and Residency Licensing/Ordination and Residency Other

What academic degree path are you interested in?

Associate's degree Bachelor's degree Other

What are three areas you identify as your strengths?

What are three areas you identify as your weaknesses?

How do you plan to fulfill the financial requirements for the Urban Leadership Residency?

Working Applying for grants and loans Both of the above Other

How did you hear about City Life's Urban Leadership Residency?

Finding your something MORE in life... begins NOW!

Description

Please allow yourself about 15-20 minutes to complete the following form to apply to the City Life Urban Leadership Residency program. Note: This is not your Indiana Wesleyan application, that will need to be filled out separately in order to be admitted to the University.

Urban Leadership Residency -- Application

Description

Please Fix the Following