ICC App

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IntentionalCollegeCommunityatOakmontSquare

ApplicationforResidency

ResidencyDatesApplyingfor:[]Fall/SpringSemesters201213TodaysDate:___/___/_____

AcademicYear:_______School:__________________________

ApplicantName_____________________________________________________________

Last

First

Middle

EducationalStatus:(FR,SO,JR.,SR.,Grad,etc.)________DateofBirth:___/___/____Gender:M/F

ApplicantsMailingAddress: Street________________________________________________

City__________________________State_______Zip_________

HomePhone:()__________CellPhone:()____________

Email:________________________________________________

NameofParent(s)orGuardian(s):__________________________________________________

AddressandPhone:

Street________________________________________________

City__________________________State_______Zip_________

(ifdifferentfromabove)

Phone(home):()__________Phone(Work):()____________

ChurchRelationship(Baptist,UnitedMethodist,etc.):__________________________________

NameofHomeChurch:__________________________________

Street________________________________________________

City__________________________State_______Zip_________

ChurchPhone:()_____________Pastor:________________

BysigningbelowIherebyaffirmthattheinformationIhaveprovidedisaccurate.Thisisonlythe
applicationanddoesnotguaranteeorreserveaspace.Iunderstandthatprovidingfalseinformation
willresultinthecancellationofmyapplication.

ApplicantSignature:_____________________________________________________________

ForOfficialUseOnly:

SentApplicationReceivedon:_____/_____/______RecordedBy:______________________

Print Form

IntentionalCollegeCommunityatOakmontSquare

ApplicationforResidencyPartII

Pleaseanswerthefollowingquestionscompletelyandhonestly.Yourresponseswillbekept
confidential.Wearenotlookingforarightorwronganswerweareseekingtoknowandunderstand
you,yourtruedesiretolivewithus,andyourdesiretoknowandserveJesusChrist.

Pleaseanswerthesequestionsinyourownwords.Typewrittenresponsesarepreferred.
1. IfyouweretoviewyourrelationshipwithGodasajourney,whereareyouinthatjourney?(I
haventbegun,welldownthepath,offthemainroad,etc.)
2. WhatexperienceshavehelpedyougrowinyourChristianfaith?
3. WhatisyourunderstandingofintentionalChristiancommunity?
4. WhatdoyouexpecttogainbylivingintheIntentionalChristianCommunityatOakmont
Square?
5. Whatdoyouexpecttocontributetothiscommunitybylivinghere?
6. Isthereanythingelseyouwouldliketo/needtoshare?(aboutyourfaith,aboutyourfamily,
aboutanyspecialneedsyouhave,etc.)

References
Pleaselisttwopeople(outsideofyourownfamily)whowecancontactaboutyoubeingapartofthe
IntentionalCollegeCommunityatOakmontSquare.
Reference#1:

Reference#2:

Name:_________________________

Name:________________________

Address:________________________

Address:_______________________

_______________________

_______________________

Phone:_________________________

Phone:_________________________

Relation:__________HowLong_____

Relation:________HowLong______

Ihavereadthisapplicationcompletely.IhavebeenhonestandcompletewiththeinformationthatI
haverecordedonallpartsofthisapplication.Iunderstandthatprovidingfalseinformationonthis
applicationmayresultinmylossofprivilegeattheIntentionalCollegeCommunityatOakmontSquare.

Signed:_______________________________________

Date:____/______/_____

ForOfficialUseOnly:

SentApplicationReceivedon:_____/_____/______RecordedBy:______________________

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