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Restoration Center

Christ for the nations

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Name*
Prefix First Last
Gender*
- Male
- Female
Marital Status*
Age*
Country of Birth*
Are you US Citizen?*
- Yes
- No
Are you a CFNI Student?*
- Yes
- No
What's your Student ID#?*
Are you a CFNI Alumnus?*
- Yes
- No
What's your Student ID#?*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Home Phone
Cell Phone*
Is this Online Application for yourself?*
- Yes
- No
If your answer is "No" please, tell us your name and relationship with the applicant.*
First Name Last Name
Phone*
Relationship with Applicant*
Faith Related
Are you in full-time ministry or a pastor?*
Are you a born-again Christian?*
What is your denomination?
What do you expect God to do for you through The Restoration Center?*
Medical Information
Have you been or are you currently under psychiatric care?*
- Yes
- No
Name of personal physician/clinic
Do you smoke or use tobacco in any form?*
- Yes
- No
Do you drink alcohol in any amount?*
- Yes
- No
Supply any other information that might be helpful for the staff to know:
Housing Accommodations
Do you need housing accommodations?*
- Yes
- No
How many rooms?
Do you identify as someone who is living with a disability that prevents you from being able to go upstairs?
- Yes
- No
About CFNI
How did you hear about Restoration Center at CFNI?*
- Online Website
- Magazine
- CFNI Staff
- Friends / Family
- Other
Please specify:
Donations are welcome and would be appreciated to help fund this ministry. (2 Corinthians 9:7-15)
Minor Ministry Consent / Release Form
Minor Child's Name:*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address of Minor Child:*
Relation with minor*
eSignature*

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