14.12 Application

8/3/2019 14.12 Application

1/12

Revised 12-6-11

Beltway Park4009 Beltway South, Abilene, TX 79606 / 325.692.6540

Application for 14:12 School of Discipleship

We are so excited that you are interested in 14:12 School of Discipleship, and we look forward totalking to you more about it. We understand that this application may seem extensive and thorough. Byhonestly and completely filling out this application you are helping us identify areas of strength andweakness in your life that we will work by Gods grace to develop for the glory of God.

All information given in this application is confidential and will only be read by the 14:12 & Beltwaystaff directly involved in the interview process.In regards to the Confidential Morals Questionnaire,male staff will review male applicants and female staff will review female applicants.Thank you foryour honest answers and comments.

Instructions:

Please answer all questions completely and legibly. Use the application form and attachadditional sheets to the end of the application as necessary.

This application may take a few hours to complete. Start early and turn in the application as soonas possible.

All applications should be turned in to the Beltway Church offices or mailed to the address listedabove.

You are required to submit three references. Be sure to give your references plenty of time tocomplete the form by the necessary deadlines. Provide your references with a stamped envelopeaddressed to:

Attn: 14:12 School of DiscipleshipBeltway Park Baptist Church4009 Beltway SouthAbilene, TX 79605

Attach a wallet/passport size photo to your application. After your application is received, you will be contacted within a week to set up an interview.

If you have any questions about the school or application process, please contact us at:(325) 692-6540

[email protected]


2/12

REQUIREMENTS AND POLICIES

Please review this page and make note of any questions you may have concerning the

requirements and policies of the school. During your interview with a member of the 14:12 Staff,

please feel free to ask any and all questions you may have.

Tuition: $550 (Jan.22nd); $650 (Feb.12th); $750 (March 25th) Activation Mission Trip: commit to participating in either the Overseas or U.S. Outreach July

16th-30th. Cost for Overseas Outreach is approx $3000; U.S. Outreach is approx $600. Tardy/Absence Policy: four tardies & two absences beyond this opens up the possibility of

dismissal. Employment Policy: students must hold a 15-20 hour/week part-time job. Dating Policy: students may not begin a dating relationship while enrolled in 14:12 Alcohol/Tobacco Policy: must be refrained from throughout the duration of the school. Entertainment Policy: the viewing of inappropriate materials is prohibited. Dress Code: conforms with the dress code of the Beltway business offices. Lifegroup: must be attended weekly. Discipleship: be discipled &expected to weekly mentor at least one other person. Beltway Worship Service: attend one of the Sunday morning worship services. Class Time: Monday-Thursday 8:30am-12:30pm Ministry Track: serve in one of the ministries within our church 3 hours per week (likely

Sunday Morning). Time with God: learning & committing to spend at least an hour with Jesus everyday. Evangelism: share the gospel 3 times each week. Scripture Memory: memorizing up to three verses each week. Fasting:participating in corporate fasts. Exercise: work out 3 times each week for 30 minutes. Sabbath:practice taking a designated day for rest in Gods presence. Required Reading: students must complete all required readings including Scripture readings

and multiple books.

14:12 FINANCIAL INFORMATION

Tuition (Covers general operating costs for the school, all books, materials, and both theorientation and closing retreats). *Funds received for your tuition costs are not tax deductible.

The Activation Mission Trip is NOT covered by tuition. The cost of the Activation MissionTrip is approximately $3,000 (U.S. $600). Students will be responsible for raising financialsupport for this trip. *Funds received for your Mission Trip costs are tax deductible.

Tuition Payment Plan

$150 non-refundable deposit is due within two weeks of acceptance to 14:12. $400 due May 25th, 2012 Remainder of tuition due by July 1st, 2012

Tuition Refund Policy

$150 deposit is non-refundable No tuition is refundable after May 29th (first day of class)

*Please retain these cover pages for your records.


3/12

14:12 Application

Personal Information

Full legal name: __________________________________

Preferred name: __________________________________

Birth date: _____________________ Gender:___________

Phone: (cell) _____________________________________

E-Mail: _________________________________________

Current Address: _____________________________________________________________________

City/State/Zip: ______________________________________________________________________

Most Recent Lifegroup Leader(s): ________________________________

Marital Status: (fill out all that apply) Single Are you currently dating anyone? __ If so, who? _________________________ Engaged Fianc's name and birth date: _________________________________________

Will your fianc be applying for the school? _____ Date of wedding: ________

Married Spouse's name and birth date: _________________________________________Will your spouse be applying for the school? ____ Anniversary: _____________

Separated Date of separation: ______________________ Divorced Number of divorces and date(s) of divorce: ______________________________ Widow/er Date of spouse's death: _______

Citizen of which country: ______________Do you have a passport? Yes / No Expiration Date: _____

Have you previously applied to this school? Yes / No If yes, were you accepted? Yes / No

If you were accepted, but did not attend, please explain: ______________________________________

If you were not accepted, why (to the best of your knowledge)?_________________________________

Why are you interested in going through 14:12?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Attach Photo Here


4/12

What expectations do you have about 14:12?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Education/Work

School you attend: _______________ Classification: _____________ Graduated? _________________

Major/Degree: _____________________ GPA: _________

How would you characterize your study habits? (Circle one)Very poor-----poor-----average-----good------very good

Do you have any learning disabilities or handicaps that would hinder you from paying attention in theclass setting or completing reading and writing homework on time (i.e. dyslexia, ADD)?

Yes No Maybe

(If so, please explain)

______________________________________________________________________________

Do you have a job? Yes / No Where do you work? ________________________ Hours/Wk: ________

Do you tithe (10%) regularly to the local church? Yes / No

Do you give offerings over and above a tithe regularly? Yes / No

Do you have any significant financial concerns? Yes No If yes, please explain:______________________________________________________________________________________________________________________________________________

Use a separate sheet (or back of page) if necessary to fully explain your answers throughout the

rest of the application. Do not hesitate to be thorough.

Family Background

List any siblings you have and their ages: ________________________________________________

Are your parents Christians and are they currently involved in a church? ________________________

What is your current relationship with your parents like? How do they feel about you doing 14:12? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Briefly describe your family background: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


5/12

Christian Experience

At what age did you become a believer? ____________________________

Describe how you began your relationship with Jesus?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________

What is your religious or denominational background? _______________________________________

Have you been water baptized by immersion? Yes / No Date: ____________________

How long have you attended Beltway Park? ________Are you a member? Yes / No

Have you been involved in occult, new age, or a cult (Mormons, Jehovah's Witness, etc.)? Yes / No

If so, explain: ______________________________________________________________________

Please describe the current nature of your level of involvement in church life (i.e. I attend a Lifegroup; Ilead a Lifegroup; serve in Kids Park; worship team) and the name of the person who directly overseesyou: _______________________________________________________________________________

How does a person gain right standing with God?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please convey your understanding of the Baptism of the Holy Spirit and your views on the gifts of the

Spirit (prophecy, tongues, healing, etc.). What has been your experience in these things?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are your plans & desires for after you complete 14:12? _____________________________________________________________________________________________________________________________________________________________________________________________________

Which ministry area are you interested in serving and receiving hands-on training in during 14:12?

1stChoice: ___________________________ 2ndChoice:____________________________

Childrens Ministry YouthWorship Media/AVAdministration/Hospitality Freedom/HealingPastoring/Preaching Outreach/Missions


6/12

Confidential Medical and Psychological Questionnaire

We recognize that a persons past is a very tender subject due to the painful experiences that many have had. However, on

the following questionnaires we need you to be extremely honest in your answers in order for us to assess how we can most

effectively help you. A past problem in an area does not necessarily exclude you from the school. The information that you

share with us will be treated confidentially and will be seen only by those directly involved in your application decision. Asstated previously, only staff of the same gender will read this portion of your application.

How many days were you absent from work (or school) due to illness in the last year? __________

Are you currently taking any medication or under a doctor's care? Y NIf so, indicate reason, medication, purpose and any limitations it may cause:

_____________________________________________________________

In the section below, if you answer yes, please explain on the back or on another sheet of paper.

Do you have any handicaps or health conditions that require special care? Y N

Do you have any chronic illnesses or allergies? Y N

Have you used any narcotics, hallucinogens or drugs not prescribed by a physician in the past 2 years? Y N

Do you now drink alcoholic beverages and if so how frequently? Y N

Do you now use tobacco products and if so, how frequently? Y N

What are your thoughts in general on consuming alcohol and tobacco products?

________________________________________________________________________________________________________________________________________________________________________________

Are you willing to abstain from the consumption of alcohol and tobacco during 14:12? Y N

Have you been treated for a drug or alcohol problem in the past two years? Y N

Do you tend to experience strong anxiety? Have you ever struggled with related symptoms Y N(i.e. cutting, panic attacks, attempted suicide, etc.)

Have you had any prolonged problems with depression or mood swings in the past two years? Y N

Have you struggled with an eating disorder (anorexia, bulimia, or overeating) in the past two years? Y NIf so, please explain the nature of the problem, extent, when you began having difficulty, and any

other specific details that may help us to understand your particular situation.

Have you seen a professional counselor in the past two years for any reason other than Y Ncareer or premarital counseling? If yes, when? For what purpose? How was it helpful?

Have you consulted a physician/psychiatrist/psychologist concerning a mental or emotional Y N

condition in the past two years? If yes, when? For what purpose? How was it helpful?

Have you ever been physically or sexually abused, or raped? Or have you been the perpetrator? Y N

If yes, please tell when this occurred and if you have seen a professional counselor.

Have you had episodes of rebellion in your life in the last two years? (defiance of authority figures, Y N

not open to accountability, defiance of rules or laws, illegal activities, etc.)

Have you ever been convicted of a crime or felony? Y N


7/12

Confidential Morals Questionnaire

1. What are your convictions regarding premarital and extra-marital physical involvement? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Have you set guidelines for yourself in the physical area to ensure minimal temptation? Yes / NoIf so, what are they? _________________________________________________________________

___________________________________________________________________________________

3. Have you had a relationship in the past two years with a member of the opposite sex that would not beconsidered above reproach? (i.e., heavy kissing, fondling, sexual intercourse, extra-marital involvement,etc.) Yes / No

If so, when was the last occurrence of involvement in this kind of relationship? (Month/year) ________

What was the extent of physical involvement? (Please be specific) _____________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If you answered yes to question 3:

Have you dated other men/women since the last occurrence? _____ If so, what has your physicalrelationship been with them? ______________________________________________________________________________________________________________________________________________

4. Please explain any current struggles with sexual temptation, masturbation, fantasy, pornography,

difficulty applying your guidelines/convictions, etc. _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Female: Have you ever had an unmarried pregnancy or abortion? Yes / NoMale: Have you ever been responsible for a girlfriend's unmarried pregnancy or abortion? Yes / No

If so, when? Explain the circumstances: ______________________________________________________________________________________________________________________________________

___________________________________________________________________________________

6. Have you had any type of homosexual relationship in the past two years? Yes / No

If so, when was the last occurrence of involvement in this kind of relationship? (Month/year)________

What was the extent of physical involvement? (Please be specific) ___________________________________________________________________________________________________________________________________________________________________________________________________


8/12

How does this affect your current relationships with the same sex? ___________________________________________________________________________________________________________________________________________________________________________________________________

Self Awareness: Please circle the 3 areas you struggle with most:

Comparison Insecurity/Low Self-Worth Materialism

Envy/ Jealousy Anger AnxietyRebellion Greed FearSelf-Justification Control ManipulationCoarse Joking Lying Co-dependencyIdolatry Pride UnforgivenessDepression Lust (Masturbation, Pornography) HatredGluttony Passivity Other________________

Do you have any additional comments or clarification about anything on this questionnaire?___________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


9/12

Revised 11-23-10

Activation Mission Trip

A huge part of 14:12 is the Activation Mission Trip where students get the opportunity to immediatelyput into practice, live-out, and see first hand many of the things learned throughout the course of theschool. Students will choose from two different trips: Overseas Outreach or U.S. Outreach.

Approximate Dates: July 16th-30th

Approximate Cost: $3000 (Overseas) & $600 (U.S) Support Raising: Students will be responsible for raising their own support. Donations made by

family and friends are tax deductible. Details: More details regarding payment dates, travel info, etc. for this trip will be available for

students after applications are received. Location of Trips: Trip locations will be disclosed to students upon being accepted into 14:12.

Due to the intensity and challenging demands of 14:12 and the Activation Mission Trip, it is bestfor students to commit to doing 14:12 out of desire to seek God, grow as disciples of Jesus, andmake disciples of Jesus, not because of any glamorous trip location at the end of the school

Which 14:12 Activation Mission Trip are you interested in going on?

Overseas U.S.

Can you commit to being active in raising your support for this trip? Yes / No

*We believe that seeking to make disciples in the nations (and U.S) is an essential part of our owndiscipleship process. Therefore, going on an Activation Mission Trip is a required for every studentattending 14:12. If you desire to do 14:12, but are unsure about the mission trip, please address this in

your interview.**Trip payment dates, etc. will be provided at your interview

Signature of Applicant:_________________________________ Date: _____________


10/12

Pastoral Reference(someone in direct authority over you in a ministry/spiritual environment)

I, _______________________________ have applied to be a student in 14:12 SCHOOL OF DISCIPLESHIP

I have referred you to 14:12 School of Discipleship for information concerning my character and fitness for this school. The

14:12 staff would appreciate your honest, straightforward answers, evaluating both my assets and liabilities. 14:12s

standards are high because of the special demands of this school. Thus, the school needs accurate information about me in a

variety of areas in order to make a fair appraisal of my character. Your PROMPT COOPERATION in filling out this form

will be greatly appreciated. Be assured that your reply will be held in strict confidence and that I will not see this form afteryou complete it.

Reference Name: _____________________________________________ Phone: _______________________

How long have you known the applicant & in what relationship? _______________________________________________

How well would you say you know the applicant? Very Well / Well / Average / Not very well / Almost Not at All

Please discuss the following areas, based on your knowledge of the applicant. If further space is needed, please attachadditional sheets.

1. Is there any indication that the applicant's decision to do the discipleship school has been significantly influenced by a

desire to escape personal, family or vocational situations? Yes / No

If yes, please explain: _____________________________________________________________________________

2. Does the applicant have the ability to make decisions and follow through on them? Yes / No

If no, please explain:______________________________________________________________________________

3. How does the applicant respond to authority?_____________________________________________________________

4. Can the applicant take responsibility and demonstrate leadership? Yes / NoIf no, please explain:______________________________________________________________________________

5. Comment on the applicant's

(a) Sensitivity to the needs, feelings and attitudes of others: _________________________________________________

(b) Ability to work with others: _______________________________________________________________________

6. To your knowledge, how does the applicant respond difficult circumstances?____________________________________

**For questions 7-10,If yes, please explain on another page.

7. Are you aware of any instance(s) of mental or emotional illness or difficulty that the applicant has had? Yes / No

8. To your knowledge, has the applicant ever used narcotics not prescribed by a physician? Yes / No

9. Do you have any reservations concerning the financial integrity and/or the indebtedness of the applicant? Yes / No

10. Have you had reason to question whether the applicant has been walking in purity? Yes / No

11. What outstanding abilities or talents does the applicant have? _______________________________________________

12. Please comment on anything else about the applicant you feel would be helpful for us in determining whether or not they

are in a good place to commit this summer to intensive spiritual training: ________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________

Signature: ________________________________________________Date: _____________________________________

This form is an essential part of each student's acceptance into 14:12. Please be prompt in returning this form. The

applicant should provide you with a stamped, addressed envelope. Mail to: 14:12 School of Discipleship, Beltway Park

Baptist Church, 4009 Beltway South, Abilene, TX 79606. Or fax to: Attn: 14:12 School of Discipleship (325) 692-9688


11/12

Friend Reference

I, _______________________________ have applied to be a student in 14:12SCHOOL OF DISCIPLESHIP



standards are high because of the special demands of this school. Thus, the school needs accurate information about me in a

variety of areas in order to make a fair appraisal of my character. Your PROMPT COOPERATION in filling out this form

will be greatly appreciated. Be assured that your reply will be held in strict confidence and that I will not see this form after

you complete it.




Please discuss the following areas, based on your knowledge of the applicant. If further space is needed, please attachadditional sheets.

1. Is there any indication that the applicant's decision to do the discipleship school has been significantly influenced by a

desire to escape personal, family or vocational situations? Yes / No





4. Can the applicant take responsibility and demonstrate leadership? Yes / No


5. Comment on the applicant's

(a) Sensitivity to the needs, feelings and attitudes of others: _________________________________________________









12. Please comment on anything else about the applicant you feel would be helpful for us in determining whether or not theyare in a good place to commit this summer to intensive spiritual training: ________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Signature: ________________________________________________Date: _____________________________________





12/12

Employer or Teacher Reference(someone in direct authority over you in your current or most recent work/school environment)

I, _______________________________ have applied to be a student in 14:12 SCHOOL OF DISCIPLESHIP



standards are high because of the special demands of this school. Thus, the school needs accurate information about me in avariety of areas in order to make a fair appraisal of my character. Your PROMPT COOPERATION in filling out this form

will be greatly appreciated. Be assured that your reply will be held in strict confidence and that I will not see this form afteryou complete it.




Please discuss the following areas, based on your knowledge of the applicant. If further space is needed, please attach

additional sheets.

1. Is there any indication that the applicant's decision to do the discipleship school has been significantly influenced by adesire to escape personal, family or vocational situations? Yes / No





4. Can the applicant take responsibility and demonstrate leadership? Yes / No


5. Comment on the applicant's(a) Sensitivity to the needs, feelings and attitudes of others: _________________________________________________









12. Please comment on anything else about the applicant you feel would be helpful for us in determining whether or not they

are in a good place to commit this summer to intensive spiritual training: ________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Signature: ________________________________________________Date: _____________________________________




Documents

14.12 Application