Off the Wall Ministry - Student Application

Discipleship Program Application

Please fully complete the application.
Upon completion of the application you will be asked to submit a $30 non-refundable admissions fee. You can pay by credit card, checking account debit or savings account debit. *please email todd@otwdiscipleship if you have any questions about this fee.

First Name

Last Name

Email

Phone Number

Birthdate

Gender

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Location Preference

Highest Level of Education

Any Educational Challenges

Yes

No

Please explain Educational Challenges

Please add an emergency contact

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

Relationship to person

How so you plan to pay tuition

Do you plan to bring a car

Yes

No

Do you regularly attend church

Yes

No

Church Name

Pastor Name

Church Involvement

If no, Please Explain

Family Background

Father's Name

Mother's name

Marital Status

How did you hear about OTW

Why would you like to be a students at OTW Discipleship?

What is discipleship to you?

Personal Testimony

Please provide 2 references who are not an immediate family members. (e.g. pastor, youth leader, employer.) We will contact them to discuss your readiness for the OTW discipleship program.

First Name

Last Name

Phone Number

Email

First Name

Last Name

Phone Number

Email