S.A.L.T. Application

First Name

Date of Birth

Last Name

Mailing Address

City

Phone Number

Parents Name

Pastors Name

Name of Church you attend

State

Zip Code

Parents Phone Number

Pastor's Phone Number

Pastor's Email Address

If yes, please explain here

Please list any and all medications that you are currently taking along with the diagnosis for each:

Primary Physician's Name

Physician's Phone Number

Please write out how you personally know that you are saved:

In your opinion, what is your greatest strength (personality and or character trait):

In your opinion, what is your greatest weakness (personality and or character trait):

In what kind of outdoor activities have you participated in or that you enjoy?

In what ways are you serving in your local church?

Rate your spiritual temperature: 10 being hot and 1 being cold (explain your answer)

How do you want God to change you this summer through the SALT Program?

I certify that my answers are true and complete to the best of my knowledge.

Applicants Signature and Date: Sign Here by holding down the left button on your mouse