PRAXIS APPLICATION FORM

PRAXIS ONLINE APPLICATION

All information provided below is secure, confidential and accessible only to the Praxis Academy Admissions Director and President.
Praxis Academy reserves the right to refuse entrance to anyone and any illegal or illicit behavior will constitute grounds for immediate dismissal.
If a required field does not apply to you, please type n/a where applicable. *If you DO NOT receive confirmation page, please re-submit. Thank You.

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you a U.S. Citizen? *

YES NO

Gender *

MALE FEMALE

Email *

HOME Number *

CELL Number *

WORK Number *

Date of Birth (day-month-year) *

Age *

SPOUSE/FIANCE INFORMATION

EDUCATIONAL AND OCCUPATIONAL HISTORY

Primary/Secondary Education (please choose one) *

Elementary School Only Elementary & Jr High Only High School Graduate

Vocation/Technical Training Completed *

1 year completed 2 years completed

Starting with current employer, please list your previous employers *

College Education *

1 year completed only 2 years completed only 3 years completed only College Graduate

Please list ALL degrees that you hold *

List all educational institutions you have attended *

Please list any occupational or professional skills that you are trained in *

FINANCIAL INFORMATION

Please identity how you plan to pay your school tution *

Please choose your payment option (only choose one) *

Option 1: $999 FULL Payment Option 2: $111 monthly payment Option 3: $333 trimester payment Option 4: $800 Family Discount (2 or more family members attending)

Please explain your current financial situation *

Will you need to request childcare through Praxis? *

YES NO

Childcare Cost as follows: $10 per child/per night ($5 for 2nd child, if applicable)

If so, how many children? *

CHURCH AFFILIATION AND REFERENCES

What denomination were you raised in? *

What is your current denomination? *

Please email a reference letter from your two references listed below to praxis@destinyhouseministries.org (reference letters are required)

What is the name of your current church? *

Name of Pastor *

Are you an active member? *

YES NO

Personal Friend Reference

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Minister Reference

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

YOUR MINISTRY EXPERIENCE

PLEASE CHOOSE WHAT YOU ARE APPLING FOR: *

EMERGENCY CONTACT INFORMATION/MEDICAL CONSENT

Emergency Contact Relationship to You *

Name *

First

Last

Emergency Contact Number *

Alternate Contact Number *

I hereby grant permission to the Praxis Academy Staff and Official Representatives to render to me and/or authorize any and all EMERGENCY MEDICAL TREATMENT as they deem necessary in the event that I am in need of such treatment. I therefore release Praxis Academy, it's Staff and Official Representatives from all liabilities in the event of an emergency. By typing my name below, I am signing my name in agreement to this Medical Consent Release form.

Please Sign and Date *