<p> American Baptist Churches of Ohio Leadership Academy</p><p>Application (please print)</p><p>PERSONAL :</p><p>Name: ______Date of Birth: ______</p><p>Home Address: ______(Street) (City) (Zip Code) (Phone)</p><p>If married, Spouse’s Name: ______E-mail Address: ______</p><p>Employment Occupation: ______</p><p>Current Employer: ______Address: ______(if retired, last employer)</p><p>Dates Employed: ______Employment Phone: ______</p><p>May we contact your employer:  Yes  No</p><p>List previous three (3) jobs and dates: (1) ______</p><p>(2) ______(3) ______</p><p>EDUCATION :</p><p>Elementary: ______years High School: ______years Diploma?______</p><p>College: ______years Degree: ______Other: ______</p><p>CHURCH MEMBERSHIP :</p><p>Church: ______</p><p>Address: ______Number of Years: ______</p><p>Pastor’s Name: ______Pastor’s email: ______</p><p>Leadership Roles in the Church: ______</p><p>If a member of the present church less than five (5) years, previous church and address:</p><p>(Over) CHURCH REFERENCE :</p><p>Your pastor will receive a reference form, which s/he will need to complete before your acceptance in the program. In addition, you need to secure an endorsement from your diaconate or other official board stating that they have voted to recommend you to the program.</p><p>REFERENCES (OTHER THAN PASTOR) :</p><p>Name Name</p><p>Street Street</p><p>City State Zip City State Zip</p><p>Phone Phone</p><p>Relationship Relationship</p><p>PERSONAL NARRATIVE :</p><p>Section One: Write a brief statement of your conversion and faith journey including your experience and faith beliefs.</p><p>Section Two: State your reasons and goals for applying for acceptance in the Leadership Training Program. For instance: What factors motivated you? Who influenced you to enroll? Where might the Lord be leading to serve? What would you like to accomplish through the program?</p><p>THE FOLLOWING ITEMS ARE NEEDED TO COMPLETE THE APPLICATION PROCESS :</p><p> I have enclosed a letter of endorsement from a Church leader in my local ABC congregation (other than the Pastor) or from an ABC Ohio Region Staff member.  I have enclosed the narrative & all parts of the application as required.  I have enclosed the $25 non-refundable fee. Please make the check payable to ABC/Ohio.  Deadline for application, endorsement letter, biography and fee may be found each year at abcohio.org.</p><p>I hereby apply for the Leadership Academy and state that all the information that I have provided you is correct to the best of my knowledge.</p><p>Signed: ______Date: ______</p><p>Please Mail Application & Check to:</p><p>Jeni Gerber, Registrar c/o First Baptist Church of Greater Toledo 6520 Pilliod Road Holland, OH. 43528 Fees for tuition are as follows: $25 — with application. $100 — upon enrollment at the orientation. $125 — before Intensive II.</p><p>*It is now a requirement to have an Email Address.</p>