21 Project Messengers Application

Before you begin:

Thanks for your interest in 21 Project. There is an application fee of $15 required to submit this application. Please have your card available in order to complete the application. If you complete the application but don’t see an email from us immediately, check your spam folder, and then contact us if you still don’t see it.

Which location would you like to attend?

First Name:

Last Name:

Email Address:

Phone Number:

Age:

Gender:

I'm a Dude I'm a Lady

Tell us your salvation story.

Why do you want to take part in this school? What are you eager to learn? What skills would you like to develop?

What are you currently doing?

Are you working through any addictions (to drugs, alcohol, pornography, smoking, etc.)? Or have you had any past addictions? (doing something that you found really hard to quit).

Are you currently on any medications? If so, for what? If you have ever been treated for any psychiatric conditions, please tell us about it here.

How did you hear about 21 Project?

Are you currently a university student?

Yes No

The Messenger track will have 2 specialties: Messengers to Colleges, and Brave Love messengers (for women only). Which specialty are you interested in?

Why do you want to be involved in this specialty?

This track is heavily focused on public communication but having a lot of experience in public speaking is NOT necessary to join this track. Please tell us, how comfortable are you with public speaking? Have you had any opportunities to preach / teach / do public communication, and if so, tell us about them...

What is your interest/vision for participating in this track?

Are you involved in campus ministry?

Yes No

Please describe your campus ministry:

What is your level of involvement?

Not very Highly Group Leader

Before you begin:

Thanks for your interest in 21 Project. There is an application fee of $15 required to submit this application. Please have your card available in order to complete the application. If you complete the application but don’t see an email from us immediately, check your spam folder, and then contact us if you still don’t see it.

Address:

City:

State:

Zip:

Country

Housing Info:

For the Lancaster 21 Project we'll be partnering with local churches and individuals to offer housing for our students. Let us know if you live within 30 minutes of Ephrata Community Church and would like to help host other students, or have connections with a potential host home or church.

Housing Status:

Emergency Contact Information:

Emergency Contact:

Relationship:

Emergency Contact's Phone Number:

$15 Application Fee - Online Payment:

Please enter the card details for the credit/debit card you'd like to use below:

First Name:

Last Name:

Credit Card Number:

Expiration Date:

CVC:

Zip: