Off the Wall Ministry

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.

Contact

✕

First Name

Last Name

Email

Phone Number

Date of birth

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

Gender

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Location Preference

Highest Level of Education

Any Education Challenges
Yes
No

if yes, please explain

Do you have health insurance?
Yes
No

Do you have any dietary restrictions?

Do you have any physical disabilities?
Yes
No

Please Explain

Do you struggle with any mental health issues?
Yes
No

Have you received counseling for this?
Yes
No

Please explain the mental heath issues that is a struggle for you:

Do you have any health problems? (examples: asthma, diabetes, heart issues, stroke, ect.)
Yes
No

Please explain any chronic health problems:

Have you ever used illegal drugs?
Yes
No

If yes, date of last use

Contact

✕

First Name

Last Name

Email

Phone Number

Add another person

How do you plan to pay tuition?

Do you plan to bring a car
Yes
No

Church History

Do you regularily attend a church?
Yes
No

Church Name

Pastor's 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?

Tell us what discipleship means 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.

Contact

✕

First Name

Last Name

Email

Phone Number

Add another person

Contact

✕

First Name

Last Name

Email

Phone Number

Add another person