Black Voices Intensive Application

We recommend writing the longer answers in a separate application and copying & pasting them here so you have back up incase you experience any issues submitting the form.

First Name:

Last Name:

Phone Number:

Email Address:

Gender:

I'm a Dude I'm a Lady

Age:

Date of Birth

Address:

City:

State:

Zip:

Country:

Emergency Contact Information:

First Name:

Last Name:

Phone Number:

Are you currently a university student?

Yes No

How did you meet Jesus and give your life to Him?

What do you hope to get out of the Black Voices intensive?

Why is the gospel an important part of the race discussion?

Are you currently on any medication?

Are there any addictions that you are currently working through?

Are there any skill sets that you have that would be helpful for us to know about?

Is there anything further you’d like to let us know?

$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:

CVC:

Expiration Date:

Zip: