HEARTLAND APPLICATION

Dear HMC Applicant,

We are excited that you are considering Heartland as a part of your future endeavors. Please take time to discover

what HMC is all about and then prayerfully complete this application and send it back to our main office. This will

begin your application process. Be sure to carefully read and complete each section of this form. At the end of the

application you will find this checklist of items to include when returning this information to HMC.

□ Completed Application□ Spiritual Questionnaire□ Typed personal testimony (200-word minimum)□ Recent Photo

□ $25 Application fee (check or money order payable to Heartland)□ Pastoral Reference form has been given to your pastor. (They will send it in separately. Online or mail.)

Once HMC has received your application materials, you will be contacted by a staff member to set up a series of

phone interviews. After these have been completed, the HMC staff will join you in praying for God's will concerning

your future in regards to admission to the program.

Please check out our website if you have any questions or feel free to call our office.

Sincerely,

HEARTLAND STAFF22881 178th Ave. Cold Spring, MN 56320 I Phone 320.597.77771

www.heartlandmc.com

APPLICATION

Full Legal Name __________________________ _ _ __ Gender: Male or Female

Current Address ------------------------------------- - --

City State Zip ------------------------- -- - -- - - -- - - - -

Home Phone Cell Phone ---------------- - -- --

Permanent Address ---------------------------------- - - - --

Email Address Name you are called by - - - - - - - - -- - - - - - -- - - -

Birthdate ------------------- --

Social Security Number ____________

Marital Status

-

- - --

If married, for how long? ___________

Spouse's Name: __________________ (please submit separate applications if both are applying)

Are you currently employed? Yes No If yes, do you have more than one job? Yes No

Phone Present employer ------------------ -

Position Date hired - - - - - - - - - - --

Past employer

Position Date hired ------------------------

Quit Fired Laid-Off

Administrative Work

Auto Repair

Carpentry

Children's Ministry

Computers

Reason Date ---------------- --

Dance

Drama

Electrical Work

Evangelism

Graphic Design

Junior High

Photography

Plumbing

Set Design

Senior High

Singing

Skate/Snow boarding

Speaking

Sports*

Teaching

Video Filming/Editing

Visitor Follow-up

Website Design

Worship*

Other*

*Sports please specify ______________________________________

*Worship please specify

PERSONAL INFORMATION

EMPLOYMENT

INTERESTS: PLEASE CIRCLE AREAS IN WHICH YOU HAVE TALENTS, SKILLS, OR EXPERIENCE

------------------

*Other please specify

Name of Father/Guardian

Current Address ------------------------------------ - - --

City State Zip------------------------- -- - -- - - -- - -- - - - - -

Accepted Christ? Yes No Occupation _____________ Marital Status ___________ _

Name of Mother/Guardian ---------------------------------- - --

Current Address ------------------------------------ - - --

City _______________________ __ State _ _ _ _ _ _ Zip _ _ _ _ _ _ _

Accepted Christ? Yes No Occupation _____________ Marital Status ___________ _

If parents divorced, how old were you? _ _ _ _ _ Are either remarried? __________________ _

Emergency Contact Name and Number-------------------------------­

List any brothers/sisters and their ages------------------------------ --

How would you describe your health? Excellent Good Fair Poor

List any physical limitations------------------------------------

List any allergies _______________________________________ _

List any medications you are currently taking -------------------------- - - --

Have you ever used illegal drugs?

Have you ever smoked tobacco?

Have you ever drank alcohol?

Yes No

Yes No

Yes No

If yes, date of last use ________________ _

If yes, date of last use ________________ _

If yes, date of last use -----------------

Have you ever had professional counseling or therapy? Yes No If yes, for what? ______________ _

Do you have health insurance? (required) Yes No Company _________________ _

Group/Policy#--------------------------- - - - - - - -�

FAMILY HISTORY

MEDICAL BACKGROUND

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T-Shirt Size: XXL XL L M s XS

How do you plan to pay for your tuition? ______________________________ _

Will you have the total by the required date? Yes No

If no, please explain---------------------------------------

Yes No Make/Model Do you own a vehicle? (required) --------------- - --

License Plate # and State - - - - - - - - - - - --

List any debts, loans and payments that you currently have and the amount due for each:

Name of home church Denomination ------------------ - - - - - - - - - - -- --

City _______________________ State _ _ _ _ _ __ Zip _ _ _ _ _ _ __

Phone How long have you attended this church? _ _ _ _ _ _ _ _ _ _

------------------Senior Pastor Youth Pastor

---------------- - --------------------

List any ministries you are currently involved in ____________________________ _

Are you a member of the church? Yes No When did you accept Christ?

Have you been baptized in water? Yes No At what age?

Have you had an Acts 2:4 experience? Yes No At what age?

How many times a week do you attend church?

Did you attend another church before this one? Yes No Denomination

FINANCIAL INFORMATION

Will these be paid off by the start of Heartland? Yes No

If no, how will you make payments?---------------------------------

CHURCH BACKGROUND

What is the approximate population of the town you grew up in? _ _ _ _ Does your family attend church? Yes No

How did you hear about Heartland?_____________ _

If accepted, are you willing to make a 9 month commitment to Heartland? Yes No

REFERENCESPlease list the name and phone number of 3 non-relative references as well as your relationship and years of connection.

Highest level of education completed High School 1 2 3 4 College 1 2 3 4 +

Approximate grade point average _ _ _ _ _ List any educational disabilities _____________ _

Other Training _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ __

Have you ever been in the military? Yes No If yes, Branch _ _ _ _ _ _ _ Years of service _ _ _ _ _

Who do you presently live with? ______________________________ _

Have you ever lived with a member of the opposite sex? Yes No If yes, please explain _ __ _ _ _ _ _ _

Divorced? Have you ever been: Engaged? Please explain ------------------

Do you have any children? Yes No Are you financially responsible for any children? Yes No

How do your parents feel about you attending Heartland? _ ___________________

Describe your family's relationship __________________________ _ _ _ _

NAME: PHONE NUMBER RELATIONSHIP YEARS KNOWN

EDUCATIONAL HISTORY

CURRENT AND PAST LIFE CIRCUMSTANCES

SPIRTUAL QUESTIONNAIRE Dear Applicant,

Please answer the following questions as honestly as possible. We are interested in understanding more about your heart and passion. If you need more paper or would like to type your responses, please attach that to this form. Additionally, you will need to include a typed personal testimony (minimum of 200 words) , recent photo of yourself and the $25 application fee.

Date Fall of Enrollment --------------- -- ------------------

Name -------------------------------------- - - - --

1. What is your definition of a servant?

2. Define your idea of ministry.

3. What characteristics are essential for a person to possess in order to be an effective spiritual leader?

4. Explain your heart in wanting to join the HMC Team and what you hope to gain from the experience.

Are you willing to live with a home opener?

Are you willing to share a room?

Yes

Yes

No

No

How did you hear about Heartland ? ________________________ _

MINISTRY PERSPECTIVE

2. Where do you plan to be in 5 years?

3. If you do not attend HMC next year, what would you do instead?

EDUCATIONAL PERSPECTIVE:

1. What role do you feel education plays in ministerial work?

APPLICATION CHECKLIST:

Before sending in your application, be sure you have included the following: □ Completed Application including your Spiritual Questionnaire□ Typed personal testimony (200-word minimum)□ Recent Photo□ $25 Application fee ( check or money order payable to Heartland)

(Also be sure you have given the Pastoral Reference form to your pastor. They will send it in separately.)

I have completed this application form honestly and to the best of my knowledge everything is accurate and true.

Signature ----------------- - - --

Date --------------- --

Please return this form directly to Heartland 22881 178th Ave. Cold Spring, MN 56320

FUTURE ORIENTATION

1. What do you plan to do after attending Heartland?

EDUCATIONAL PERSPECTIVE

APPLICATION CHECKLIST