FMMC :: Fort Myers Master's Commission

Full Name:

Name you go by:

Present Address:

City:

State:

Zip:

Permanent Address:

City:

State:

Zip:

Phone Number:

Cell Number:

Email Address:

Date of Birth:

Current Age:

Soc. Sec. Number:

Marital Status: (Married, Single, Divorced, Separated, Engaged)

Past/Present Emotional History

Use and X for past and an O for present. Please leave blank if it doesn't apply to you.

Abortion
Abused as a child
Anger/temper
Anxiety
Bitterness
Compulsive gambling
Depression
Doubts about salvation
Eating disorder
Extreme body piercing/ cutting
Family problems
Fighting
Fearfulness
Homosexual or lesbian lifestyle
Insomnia
Inability to concentrate
Lying problems
Learning disabilities
Night terrors (dreams)
Nervous disorders
Pornography
Problems with social relationships
Problems with parents
Reading comprehension
Sadness
Stress
Sexually Promiscuous lifestyle
Suicide attempts
Theft, shoplifting, stealing
Thought of suicide
Trouble making decisions
Use of alcohol, drugs, tobacco, etc.
Unstable job record
Witchcraft/ Occult

Please explain or make comments below:

Family History

Father/Guardian

Name of Father or Guardian:

Address:

City:

State:

Zip:

Occupation:

Accepted Christ? (Please enter Yes, No, or Not Certain)

Mother/Guardian

Name of Mother or Guardian:

Address:

City:

State:

Zip:

Occupation:

Accepted Christ? (Please enter Yes, No, or Not Certain)

Are your parents:

Please type an X next to the statements that describe your family history (Please leave blank if it doesn't apply to you.):

Excellent Christian home
Parental job instability
Warm relationship with parents
Relatives lived nearby
Warm Relationship with brothers/ sisters
Close relationship with extended family
Sibling Rivalry
Physical abuse as a child
Father/mother absent
Mental/ emotional abuse

If parents were separated or divorced, how old were you at the time?

Who did you live with and how long?

Father remarried?

Mother remarried?

If father is deceased, how old were you at the time?

If mother is deceased, how old were you at the time?

If you had step-parents, how did they relate to you? (kindly, poorly, affectionately, little discipline)

Step father’s name and occupation:

Step mother’s name and occupation:

How many times was your father married?

Your mother?

Medical History

How would you describe your health?

List any allergies:

List any physical limitations:

List any medications you are currently using:

Have you ever used illegal drugs?

If yes, date of last use:

Do you currently smoke?

If yes, date of last use:

Do you drink alcoholic beverages?

If yes, date of last use:

Employment

Are you currently employed?

Present Employer:

Position:

Date Hired:

Past Employer:

Position:

Date Hired:

Quit, Laid Off, or Fired Date:

Financial Background

How do you plan to pay for your tuition?

Will you have the total amount by the first day of Master’s Commission?

If no, please explain:

Do you own your own vehicle?

Do you have health insurance (required upon acceptance)?

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

Will your debts be paid off by the start of Master’s Commission?

If no, how will you make payments?

Church Background

Name of Home Church:

Denomination:

Address:

City:

State:

Zip:

Phone Number:

Name of Senior Pastor:

Name of Youth Pastor:

How long have you attended this church?

List the different ministries you are presently involved in:

When did you accept Christ?

Where?

Have you been baptized in water? (not required for acceptance)?

Have you ever had an Acts 2:4 experience (not required for acceptance)?

Personal Essays

How did you hear about FMMC?

How do your parents/ guardians feel about you coming to FMMC?

How do you plan to pay for your tuition?

Describe how you are personally being discipled:

Why do you think God is calling you to Master’s Commission?

Please list your options for next year (including FMMC) in order of your desire:
1st Option:

2nd Option:

3rd Option:

Please Explain:

If accepted into FMMC, are you willing to make a nine-month commitment?

I have honestly completed this application form and have answered the questions to the best of my ability. I have read the overview and I am willing to abide by all guidelines stated.

Please Type Your Name:

Date: