Application & Profile
Please Print Legibly

Candidate's name: ___________________
Address: ___________________________ City: ___________ State: ____ Zip: ______
Phone: (     )___________________ E-Mail Address: ________________________
School: ________________________ Grade: ________ Graduation year: _________
Birthdate: ___________ Age:________
Hobbies/Sports: _________________________________________________________
Church: ________________________________ City: _________________________
Senior Pastor: ___________________ Youth leader/Pastor: ____________________
Have you been baptized in water? _ Yes _ No

Briefly give a testimony of your born-again experience: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

What is your vision/dream for your school?
____________________________________________________________________ ____________________________________________________________________

Why do you want to be a Campus Missionary?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Pastor's Reference

_____ Yes, I recommend this student for appointment as a Campus Missionary.

_____ No, I am unable at this time to recommend this student for appointment.

Pastor's Signature _______________________________________________________

(Please use back of application for more or attach additional pages as needed.)
I understand that I will not receive appointment until this application has been
received completed in full with my pastor's signature.

Send application to:
Campus Missions, PO Box 1965, Grand Island, NE 68802
Phone: (308) 384-1234
E-mail: Jenny@neag.org