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CLC Online Application

Personal Information

Academic Year for which you are applying	2013-14 2014-15	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

Name(s)
Address
City	State	Zip
Home Phone #	Work Phone #

Education

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

Employment

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 #
Address
City	State	Zip

Please list your involvement and leadership experience.

Self-Evaluation

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

Essay

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