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CLC Online Application

Personal Information

Academic Year for
which you are applying
Social Security #
Full Name Home Phone #
Work Phone # Cell Phone #
Email Address Date of Birth
Email Address (again) Age
Personal webpage URL T-shirt size Sm. Med.
Lg. X Lg.
Permanent Address
City State Zip
Campus/Local Address Campus/Local Phone
Marital Status Single Engaged
Married Divorced
Sex male female

Parent/Guardian/Spouse Information

City State Zip
Home Phone # Work Phone #


High School
City State Zip
Year Graduated GPA  
Extracurricular Activities
Intended major at Centenary


Company Name Dates Employed
Position Phone
Company Name Dates Employed
Position Phone

Clergy Reference and Church Involvement

Clergy's Name Years Known
Church/Parish Name
URL Phone #
City State Zip

Please list your involvement and leadership experience.


On a scale of 1 to 10, with 10 being the highest, please evaluate your personal strengths and weaknesses.

Relating to people Conversing with strangers Solving problems Sense of humor
Submitting to leadership Encouraging Others Maintaining friendships Listening
Establishing relationships Completing tasks Setting an example Confronting


Please write a 500 word essay on your spiritual autobiography. This essay should include information of your past and present church relationship and the future direction you hope to take in that relationship. In addition, you may describe personal accomplishments, struggles and goals.

Current Photo

We request a current photo of each applicant for our files. Please mail the photo to the address below.

Reverend Valerie Robideaux, Director Christian Leadership Center
Centenary College of Louisiana
2911 Centenary Boulevard
Shreveport, Louisiana 71104