Application form for OneEleven Intensives
Please answer all the following questions. If you have any questions or other comments you want to let us know, don't hesitate to contact us - (insert local intensive contact email)

Please keep this information in mind before beginning:
- The application will probably take about 15 minutes to complete
- The application will need to be finished in one sitting (cannot save & resume later)
- Don’t hit the “back” button or “refresh” button on your browser, or you will lose your progress
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Email *
Personal Information
First/given name *
Last/family name *
Email *
Phone *
Gender *
Street address *
City *
ZIP/postal code *
Country *
Date of Birth *
MM
/
DD
/
YYYY
Country of Citizenship *
English proficiency level *
What is your proficiency of speaking, reading and writing English?
minimal
fluent
Family Information
Marital status *
If married, is your spouse coming? *
Pastoral reference contact information
We will contact your pastoral reference about your application to participate in this program.
Pastoral reference full name *
Relationship of pastoral reference contact *
Pastoral reference primary phone *
Pastoral reference secondary phone *
Pastoral reference email *
Emergency contact information
Emergency contact's full name *
Relationship to Emergency contact *
Emergency contact primary phone *
Emergency contact secondary phone *
Emergency contact email *
Other Personal Information
Christian Life & Call *
Describe shortly your conversion experience and present relationship with the Lord Jesus
Personal Devotional Live *
Briefly describe your personal devotional life and indicate whether you are meeting your own expectations for personal spiritual growth.
Are you involved in a house of prayer and/ or church? If so, what does that look like? *
Which musical instruments can you play in a worship team? *
If we are able to organise group music lessons, in which musical instruments would you like to have lessons? *
Do you have experience in leading worship with a team? *
What are the reasons for your application? *
Specifically, what interests you in the OneEleven Intensive? What do you hope to gain from attending? How do you see yourself using the tools you learned in the OneEleven Intensive?
How did you first hear about the OneEleven intensives? *
Health information
Please note that sharing the following will not exempt you from attending. We only want to make sure this is a healthy place for you and that you will receive any support you may need while attending.
Allergies to medicines *
if you are alergic to medicines, please list and specify
Medications *
If you are taking any medications or you are under doctor's treatment, please explain
Physical Health problems *
Do you have any health problems or physical limitations (eg. epilepsy, diabetes, recent major operation etc.)? If so, please explain.
Mental Health problems *
Describe any current psychological problems for which you are receiving treatment or have received treatment for in the past (e.g. anxiety, depression, panic attacks, suicidal thoughts, psychological disorders)
Struggles *
Because of the neighbourhood in which we will be holding this seminar, please let us know if you have past history in, currently struggle with, or have been victim to: sexual abuse or promiscuity, homosexual relationships, domestic violence, pornography, excessive drinking, taking of illegal drugs or abusing legal drugs, depression, suicidal thoughts, eating disorders, or anything else you would like to make us aware of.
Food preferences and food allergies *
We will do our best to make food available which meet your expectations but we will not be able to fulfill all your detailed preferences.
Required
Finances
To be paid BEFORE arriving in Intensive location AFTER being accepted (more details in your acceptance package).
Price Options *
All options contain tuition, food and accommodation.
Statutory Declaration
Declaration #2 *
Required
Declaration #3 *
Required
Declaration #4 *
Required
Declaration #5 *
Required
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