Waldensian Center Application (2023-2024)
Page 1
Review
Thankyou
Page 1
Personal information
Current date
Last Name
Middle Name
First Name
Birthplace
Date of Birth
Age
Gender
*
Male
Female
Other
Change of Gender?
*
Yes
No
Have you ever undergone a gender change?
Phone1
(
)
-
Email
Education
Educational Background
Home Schooled
Yes
No
Secondary (high School)
None
Some
Completed
College/University
None
Some
Completed
Other Education
Undergraduate
Graduate
Post Graduate
Other
Medical Information
Medical History
Medical History
Heart Disease
High Blood Pressure
High Cholesterol
Diabetes
Asthma
Thyroid Problem
Cancer
Kidney Problem
Other
General Health
Rate Your General Health
Bad
Fair
Excellent
Unsure
Prior surgeries and any other health condition
Mental disability or condition?
Yes
No
Have you ever been diagnosed with any mental disability or condition?
If so, Please describe
Social History
Social History
Are You Currently Employed?
Yes
No
Marital Status
Single
Marired
Divorced
Separated
Widowed
Tobacco Usage
Yes
No
Recreational Drug Usage
Yes
No
Alcohol Usage
Yes
No
Other Details
Please give any other details to describe your educational background
Religious
True SDA
*
Yes
No
Are you a true Seventh Day Adventist in Spirit and doctrine?
1889 Principles
Yes
No
Still Studying
Member of 1889 HSDA
Yes
No
Are you a member of a church that is part of 1889 historic Seventh Day Adventists?
Conversion experience
Please share about your conversion experience, and your religious background.
Waldensian Center Attendance
Where did you hear about WC
Reason for attending
State your reason for attending and your plans when you complete the training
Requirements
*
Agree
Disagree
Description, Requirements, Rules:
Applicant must have read the description, the requirements and rules, and agree to abide by them.
References
References
Agree
Disagree
Reference Form
Please have your references submit these online forms.
Name 1
Phone2
(
)
-
Email 1
Name 2
Email 2
Phone 3
(
)
-
Emergency Contact
Full Name
Relation
Phone 4
(
)
-
Contact Email
Permanent or Mailing Address
