Jesus Foundation Application Form

Scholarship Selection Application Form

www.jesusfoundation.net

info@jesusfoundation.net

1-407-900-7458

234-(0)-701-228-5517

ACADEMIC INFORMATION
Have you completed Secondary School?*

Yes No Dropped out
Name of Secondary School*

Address of Secondary School*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Graduation date*
/ Month / Day Year
Expected graduation date*
/ Month / Day Year
Provide Reason:*

Secondary School results*

	A(s)	B(s)	C(s)	Other(s)
How Many SSCE/GCE:

Are you planning on pursuing a Post-secondary education?*

Yes No
Explain*
Are you currently in College/University?*

Yes No
What are you doing now*
Name of College/University*

Address of College/University*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Discipline/Major*
Matriculation date (mmm/dd/yyyy)*
/ Month / Day Year
Date of graduation (mmm/dd/yyyy)*
/ Month / Day Year
Current GPA*
When over the next 6 months would you NOT be available for training- program could range from 1 week to 3 months

EMPLOYMENT INFORMATION
Are you currently employed or have you secured employment post-graduation?*

Yes No
What is you current monthly take home pay*
Name of Employer*
Position*
Explain your source of livelihood:*
Are you self-employed or have a business or a joint venture with other individuals?*

Yes No
What is your current take-home pay*
Your source of livelihood:*
Are you a missionary or do you rely on churches and other organizations for funding?*

Yes No
What is your current take-home pay*
Current Source of livelihood*
If you marked No for all of the above, explain your plans to gain employment (this includes plans to start a business of your own or other opportunities you may be pursuing).*

	At Home	Business Center	At School/other
Where do you obtain access?

	At Home	Business Center	At School/other
Where do you get access?

	Parents’/Relative’s home	Own home	Rent	Campus
Accommodation situation?

	Parent’s car	Own car	Public transportation	Other
How do you get to school ?

	Parents	Self-sponsored	Scholarship	Relatives
Who pays for your tuition, room, and books?

WRITE-UP

In the space provided below, describe how you intend to leverage on your existing or prospective skill set (e.g. computer skills) or interests (e.g. hospitality/fashion etc.) to gain employment or create a business.
If you have not started pursuing your interest, please explain why.*

REFERENCES

Provide two character references (i.e. teachers, lecturers, pastors, employers (current or previous), please do not include family members or relatives).
Name*
Title & Place of employment*
Contact Email*
Contact Phone*
Relationship to Referee*
Name*
Title & Place of employment*
Contact Email*
Contact Phone*
Relationship to Referee*
Name of Applicant (Print)*
Name of Parent/Guardian (for applicant under the age of 18 years)
Signature of Applicant

Clear
Signature of Parent/Guardian (for applicant under the age of 18 years)

Clear
I certify the above information is true and correct to the best of my knowledge*
* Please note- if you are completing this application online and submitting it through the web you do not need to print this form in order to sign it. Instead, by checking the "I certify the above information is true and correct to the best of my knowledge" box, we would accept this as your electronic signature. Please sign this form if you are submitting a scanned version through email, otherwise your application will not be accepted.

DISCLAIMER- LIABILITY
Jesus Foundation does not provide liability insurance for the protection of individuals, groups, organizations, businesses, spectators, volunteers or others who may participate in the training program(s) sponsored or organized by us or for which we provide scholarships.

In consideration for your participation in the training program(s), the individual, group, organization, business, spectator, volunteer, or other, does hereby release and forever discharge Jesus Foundation, and its officers, directors, board, employees and volunteers, jointly and severally from any and all actions, causes of actions, claims and demands for, upon or by reason of any damage, loss or injury, which hereafter may be sustained by participating in the training program(s).

This release extends and applies to, and also covers and includes all unknown, unforeseen, unanticipated and unsuspected injuries, damages, loss and liability and the consequences thereof, as well as those now disclosed and known to exist. The provisions of any state, federal, local or territorial law or state providing substance that releases shall not extend to claims, demands, injuries, or damages which are known or unsuspected to exist at this time, to the person executing such release are hereby expressly waived.

I hereby agree on behalf of my heirs, executors, administrators and assigns, to indemnify Jesus Foundation and its officers, directors, board, employees and volunteers, jointly and severally from any and all actions, causes of actions, claims and demands for, upon or by reason of any damage, loss or injury which hereafter may be sustained by participating in a training program sponsored or organized by us or for which you are a scholarship recipient.

It is further understood and agreed that said participation in a training program is not to be construed as an admission of any liability and acceptance of assumption of responsibility by Jesus Foundation, its officers, directors, board, employees and volunteers jointly and severally, for all damages and expenses for which Jesus Foundation, its officers, directors, board, employees and volunteers become liable as a result of any alleged act of the applicant.
Name of Applicant (Print)*
Name of Parent/Guardian (for applicant under the age of 18 years)
Signature of Applicant

Clear
Signature of Parent/Guardian (for applicant under the age of 18 years)

Clear
I certify the above information is true and correct to the best of my knowledge*
* Please note- if you are completing this application online and submitting it through the web you do not need to print this form in order to sign it. Instead, by checking the "I certify the above information is true and correct to the best of my knowledge" box, we would accept this as your electronic signature. Please sign this form if you are submitting a scanned version through email, otherwise your application will not be accepted.

CERTIFICATION AND AUTHORIZATION FOR RELEASE OF INFORMATION
I certify that all of the information I provided above is to the best of my knowledge and belief, true, correct and complete. I understand that any false statements made in this questionnaire would disqualify my application.

I hereby authorize Jesus Foundation, its officers, directors, board, employees and volunteers to contact my references and/or academic institutions to verify the information provided in this questionnaire/application.

I hereby further authorize Jesus Foundation and any of their authorized representatives to use, disclose, release and furnish personal information I provide to persons or organizations for the purpose of selecting and determining my eligibility for a training program.

I understand that this information will be used to determine my eligibility for a training program and the completion of this questionnaire does not guarantee my acceptance.

Should I be accepted into a training program under the auspices of Jesus Foundation that I have identified will be beneficial to me, I agree to participate in all activities including sessions on the gospel of Jesus Christ.

Jesus Foundation promotes its activities via the use of different media sources including but not limited to social media, online/website, printed material, audio or video recording etc.

I hereby grant permission to the rights of my image, likeness and sound of my voice (hereafter referred to as "likeness") as recorded on audio or video tape or photograph during a Jesus Foundation sponsored training program, without payment or any other consideration. I understand that my likeness may be edited, copied, exhibited, published or distributed for the purpose of promoting Jesus Foundation. I waive the right to inspect or approve any such promotional product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my likeness for the purpose of promoting Jesus Foundation. I also understand that this material may be used in diverse educational/training settings.

By signing this release I understand this permission signifies that my likeness may be electronically displayed via the internet or in a public educational setting.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing my information or likeness for the purposes of promoting Jesus Foundation and its activities.
Name of Applicant (Print)*
Name of Parent/Guardian (for applicant under the age of 18 years)
Signature of Applicant

Clear
Signature of Parent/Guardian (for applicant under the age of 18 years)

Clear
I certify the above information is true and correct to the best of my knowledge**
* Please note- if you are completing this application online and submitting it through the web you do not need to print this form in order to sign it. Instead, by checking the "I certify the above information is true and correct to the best of my knowledge" box, we would accept this as your electronic signature. Please sign this form if you are submitting a scanned version through email, otherwise your application will not be accepted.
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