Preferred First Name

Surname

Address Line 1

Address Line 2

Town/City

County

Country

Postcode

Home Telephone

Mobile

E-mail Address

Gender

Please indicate if you have any special needs or are under medical treatment.  

Please indicate if you have been convicted of any offence in relation to children or been refused permission to work with children.

How long have you been a Christian? If less than 5 years please indicate the number of years and months.

Briefly describe how you became a Christian and your subsequent Christian experience.

Briefly comment on your relationship with God at this present time.

Please provide details of your Christian service experience to date. For example: preaching, leadership, children’s ministry etc.

Please explain the level of educational or professional qualifications you have achieved, if any. Though there is not a minimum entry requirement for the ACT course, a level 2 standard of literacy (such as a GCSE grade C in English Language) is highly recommended.

Please explain why you want to enrol on the ACT course.

Church Leader’s First Name

Surname

Address Line 1

Address Line 2

Town/City

County

Country

Postcode

Contact Telephone

E-mail Address

To the best of your knowledge is the information contained in this form true?

Yes

No

SPIRITUAL HISTORY

PREVIOUS EXPERIENCE

CHURCH LEADER’S DETAILS (to act as a reference in support of your application form)

APPLICANT’S DECLARATION

PERSONAL DETAILS