Date: Social Security Number:
          ^{(month, day, year)}
Name:
                    ^{(last)                                                                           (first)                                                                             (m.i.)}
Address:
                           ^{(street number and name)                                                                                (apartment number)}
City: State: Zip:
Country:
Phone (home): () Phone (work): ()
Phone (cell): ()
Date of Birth:
                              ^{(month, day, year)}
Email:
Church background:

Ministry involvement, past and present (use additional paper if needed):

Please provide your personal testimony of salvation on a separate sheet of paper. Use 250 – 300 words, double-spaced, and sign your name.

Please provide three personal references, including your pastor's if you are not from The River Church, plus friends or relatives. Please have each provider personally submit their reference directly to RCSM.

I, ,
          ^{(your name)}
agree to comply and cooperate with all the requirements listed in the student information and application form.