Impact Application Form

This form is to be completed by applicants who wish to be considered for the ChristCentral Churches Impact programme

A copy of our publicity leaflet showing an IMPACT OVERVIEW and the FEES is available to view at www.christcentralchurches.org/training.

If you have any problems completing this form please email: impact@christcentralchurches.org

1. Personal details
Surname:
Your answer
Forename:
Your answer
Your age range at start of course:
Marital Status (optional):
Address (excluding postcode):
Your answer
Post Code
Your answer
Mobile number:
Your answer
Email address:
Your answer
Do you have a full driver's licence?
Will you have the use of a car for the training blocks in Shrewsbury?
2. OCCUPATION
Current Occupation:
Your answer
Job title and main responsibilities:
Your answer
3. EDUCATION  
Highest educational qualification and where obtained:
Your answer
4. CHURCH LIFE
Name of Church you belong to:
Your answer
City/Town
Your answer
How long have you been a member?
Name of Lead Elder:
Your answer
Email address of Lead Elder:
Your answer
Please state your current church responsibilities:
If you are employed by your church and your answers are the same as in Section 2 you may type 'see Section 2' in this box
Your answer
5. PREVIOUS TRAINING/EXPERIENCE
Please give details of any ministry training or experience which has developed your skills:
(if none type 'none')
Your answer
Name of church or organisation this was done with:
Your answer
What discipling have you had in the past or are currently having?
(if none type 'none')
Your answer
Who has done/is doing the above with you?
Your answer
What (if any) systematic biblical and theological studies have you undertaken?
(if none, type 'none')
Your answer
6. BACKGROUND INFORMATION
TESTIMONY
Please write down a brief summary of your testimony below in less than 2000 characters, such as how you became a christian, water baptism and baptism in the Holy Spirit:
Your answer
STRENGTHS AND WEAKNESSES
Please write down a brief summary of your strengths and weaknesses below in less than 2000 characters:
Your answer
REASON FOR APPLYING
Why have you applied to the Impact programme?
Your answer
7. HEALTH & DIET
Are you generally in good health?
If you answered no, or you are taking medication under a doctor's direction, and your condition could affect your participation on the course we would appreciate more details, but these are not compulsory:
Your answer
We serve meals during Impact training. Do you need a special diet?
If you have answered yes to the above, please give details:
Your answer
8. FINANCE
The Impact fees are due in full the September you start the course. They can be paid by bank transfer or cheque. Please select your preferred option below:
Paying the Impact Fees
Please select your preferred option below:
Provide email address for invoice:
Invoices will be emailed. Please tell us the email address where the invoice is to be sent to:
Your answer
Please be aware that the course fee will normally be non-refundable. If you have to drop out part way through the year a partial rebate may be available in exceptional circumstances.
Please check the box to indicate you understand the terms
Required
9. REFERENCE
Your application will not be processed until we have received a reference from one of your elders answering some questions about you and confirming their endorsement and support of you doing the course.
Name of Elder we are to contact for your reference
Your answer
Email address for Elder named above
Your answer
Telephone number for Elder named above:
Your answer
10. IMPACT BASE
You must be based at a ChristCentral church running an Impact project.
Do you know which ChristCentral church you will be based at?
Name of Impact project base church:
Your answer
Name and email address of project leader:
Your answer
If you would like additional help to make a decision, or to make contact with your chosen project, please check the box below and contact GRAHAM ANNS at impact@christcentralchurches.org
11. TRAINING BASE and FURTHER INFORMATION
The Impact training blocks are hosted by Barnabas Community Church Shrewsbury on behalf of ChristCentral Churches Worldwide (part of Newfrontiers) Registered Charity No. 1151447

The training base address is:- Longden Coleham, Shrewsbury SY3 7DN

If you have any further questions then please type them in the box below, or email GRAHAM ANNS at impact@christcentralchurches.org
Your answer
12. DATA PROTECTION
The information given by you on this form will be stored electronically in a safe and appropriate manner, for the purpose of Impact administration only. By completing this form you are consenting to your information being stored as set out above.
Please confirm your consent below:-
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