Enrollment Form - HEART Village - Sustainability Training in Central Florida

Name*

First Middle Last

Maiden Name

Gender*

Male

Female

Date of Birth*

Are you a US Citizen?*

Yes

No

If no, please write in your country of citizenship

Marital Status*

Name and ages of children (if they will accompany you to H.E.A.R.T.)

Are you a Christian?*

Yes

No

Religious Affiliation*

Are you involved with a Mission Organization?*

Yes

No

If yes, which one(s)?

Please upload a recent photo of yourself

Max. file size: 300 MB.

Alternatively, you can mail a photo prior to your arrival.

What year would you like to attend?*

Which term would you like to attend?*

15 Week Spring Term (January - May)

3 Week May Term (Mid May - Early June)

15 Week Fall Term (August - December)

US Address

Street Address Address Line 2 City State ZIP Code

Non-US Address (if applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone Number*

Secondary Phone Number

Primary Phone Type*

Home

Cell

Work

Secondary Phone Type

First Choice

Second Choice

Third Choice

International Phone Number (if applicable)

Email*

Are you 21 years of age or older?*

Yes

No

I am interested in attending H.E.A.R.T. for:*

Professional Development

College Credit

1. School

1. Location

1. Date of Graduation

3. School

2. Location

2. Date of Graduation

3. School

3. Location

3. Date of Graduation

List your extracurricular activities*

Will you apply for the matching scholarship?

Yes

No

Confirmation form for the Case Matching Scholarship should be submitted no later than one month prior to the beginning of a program.

Do you attend church regularly?*

Yes

No

Describe your church involvement.*

List your previous cross-cultural experiences.*

Describe your vocational/ministry goals.*

In your own words, explain why you want to attend H.E.A.R.T. Missionary Training Institute.*

The H.E.A.R.T. Institute life-style is based on the principals of Biblical Christianity. Each member of the H.E.A.R.T. Institute community – students, staff, and faculty alike – is called upon to observe Christian standards and commit oneself to the following:

To worship God as the Creator and Owner of all things
To be a faithful steward of my resources, using them to serve God and humanity
To commit oneself to the task of sharing the good news of God’s love to all humanity
To learn issues of injustice and seek to relieve the suffering of the poor and oppressed
To renounce wasteful, extravagant personal living and embrace a simple life-style guided by holiness, humility, and contentment
To demonstrate respect for others and self at all times
To abstain from the use of alcohol, tobacco, and illegal drugs

As a candidate for admission, I understand and accept the life-style of the H.E.A.R.T. Institute. By signing the application form, I commit myself freely and faithfully, if admitted, to uphold the ideals of the H.E.A.R.T. Institute and personally to abide by the Life-Style Commitment. I further understand that violation of the code makes me subject to discipline or expulsion from the H.E.A.R.T. community.

Signature

Date

Upon Completing this online application, you must:

1. Submit your $20 application fee by check to the address below or via paypal on our website.

2. Download, print, complete and return the following forms to H.E.A.R.T. at the address below. (These links are also available on the website.)

Health Form (to be filled out by your physician.)
Medical Release Form (to be filled out by you.)
Work Reference Form (to be filled out by your professor or boss.)
Spiritual Reference Form (to be filled out by your pastor or mentor.)

The H.E.A.R.T. Institute does not discriminate on the basis of race, color, national or ethnic origin.

H.E.A.R.T. Institute 13895 Highway 27 Lake Wales, FL 33859