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Semester 2:52 Application
Basic Info
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Indicates required field
Name
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First
Last
Birth Date
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Sex
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Male
Female
Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Shirt Size
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Small
Medium
Large
XL
XXL
XXXL
Email
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Highest Attained Education Level
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High School/GED
College/Undergraduate Studies
Masters/Graduate Studies
Why do you want to attend Semester 2:52?
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Home Church
Church Name
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City
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State
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Pastor's Name
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How long have you been attending?
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Health
Do you have any disabilities?
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Yes
No
If yes, please explain:
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Have you ever been diagnosed with any diseases?
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Yes
No
If yes, please explain:
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Have you every been treated or been recommended treatment for any mental or emotional condition?
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Yes
No
If yes, please explain:
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Are there any other specific physical, mental, or emotional needs you have?
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Yes
No
If yes, please explain:
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Please list any current medications you are taking and their purpose:
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Please list any food, medications, and/or insect allergies and describe reaction as well as management of reaction:
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Insurance
Insurance Company
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Insurance Policy #
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Billing Address
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Line 1
Line 2
City
State
Zip Code
Country
Company Phone Number
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Emergency Contact
Name
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First
Last
Phone Number
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Relationship to Applicant
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History
Answering "yes" to any of the following questions will not necessarily disqualify you from attending the Semester 2:52.
Have you used tobacco, illegal drugs, or abused alcohol anytime in the last 3 years?
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Yes
No
If yes, please explain:
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Have you ever been involved in sexual immorality (pre-marital sex, adultery, pornography)?
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Yes
No
If yes, please explain:
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Have you ever been arrested or convicted?
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Yes
No
If yes, please explain:
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Have you ever been involved with the occult or witchcraft?
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Yes
No
If yes, please explain:
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Previous Employment
Please list any previous work experience you may have.
#1 - Company Name
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Position
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Company Address
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Line 1
Line 2
City
State
Zip Code
Country
Dates of Employment
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Company Phone Number
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#2 - Company Name
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Position
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Company Address
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Line 1
Line 2
City
State
Zip Code
Country
Dates of Employment
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Company Phone Number
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#3 - Company Name
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Company Address
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Line 1
Line 2
City
State
Zip Code
Country
Position
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Dates of Employment
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Company Phone Number
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Essay Questions
Provide a one or two paragraph response for the following writing prompts:
Describe your introduction to Christ and his teachings.
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Describe your spiritual beliefs.
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Describe your current relationship with Christ.
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Describe your past adventure experience (i.e. rock-climbing, backpacking, hiking, international travel)
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References
Provide two different references for your Semester 2:52 application. You may not use family members as references.
Reference #1 - Name
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Reference #2 - Name
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Relation to Student (e.g. professor, pastor)
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Relation to Student (e.g. professor, pastor)
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Phone Number
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Phone Number
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Email
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Email
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How did you hear about Semester 2:52?
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By pressing "Submit Application" I am declaring that the information provided on this application is correct and true to the best of my knowledge. I authorize the Semester 2:52 Staff to verify any and all information provided on this application.
Submit Application
