I apply for grade __________ beginning _______________ to Timothy Mentee as follows:

My Name is ______________________________________ AND my Date of Birth and Year is ________________________(mm/dd/yyyy).

My parents' names: Father's name is __________________________ and/or Mother's name is __________________________.

I have gone to the School Named as _______________________________________________

from my Home Addressed at ___________________________________________ in country of ____________________________.

I desire to go to the University of ______________________ in the year of ___________________

to become a Profession of _____________________________________________.

I believe authentic the Bible, virgin birth of Jesus Christ, vicarious death of Jesus Christ for our sins, sufficient work of the Holy Spirit, Bodily resurrection, and Jesus coming again to establish His Kingdom on earth.

My guardian and I waive any rights to claim against Timothy Ministry, Calvary Chapel of Anaheim Hills, Calvary Chapel La Semilla, Calvary Chapel of Costa Mesa, and/or any persons working for the Calvary Chapels, for any accidents or negligence arising from the lodge at CCAH Corona Ranch Horizons Mission House.

I have two references' email Addresses (1) ______________________________ and (2) _______________________________.

HEREBY, my guardian and I understand and sign on the date of _________________________,

__________________________________(my guardian's name & signature) and

__________________________________(my name & signature)

p.s. My guardian and/or I have any other questions/comments (if any, please write down)

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

And please mail it with non-refundable $100 application fee (cashier check) to CCAH Timothy Ministry, PO Box 27693, Anaheim Hills, CA 92809, USA at earliest possible, not later than July 1 .

For any questions, please email or call at USA 714-797-0454.