Application form sample

Step 1 of 5

20%

The Basics

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City Province / State Postal / Zip Code Country

Email(Required)

Preferred Phone(Required)

Cell Phone

Gender

Birthdate

MM slash DD slash YYYY

Primary Citizenship(Required)

Country

Secondary Citizenship

Country

The Details

Current / Most Recent School(Required)

Start Date(Required)

MM slash DD slash YYYY

Anticipated Completion Date(Required)

MM slash DD slash YYYY

Courses Completed in Most Recent / Current School Year(Required)

Please make a list of your courses with their full name and course code

Did you attend more than one secondary school?

Yes

If yes, please add them here:

School #2 Name

School #2 Start Date

MM slash DD slash YYYY

School #2 Completion Date

MM slash DD slash YYYY

School #2 Courses Completed

Please make a list of your courses with their full name and course code

School #3 Name

School #3 Start Date

MM slash DD slash YYYY

School #3 Completion Date

MM slash DD slash YYYY

School #3 Completed Courses

Please make a list of your courses with their full name and course code

If you've already completed High School, what have you been doing since graduating?

Indicate below how comfortable you are with the following activities, with 1 being ‘not comfortable at all’ and 5 being ‘very comfortable.

Going on extended (4-9 day) outdoor camping trips(Required)

Travel outside of Canada(Required)

Living in a community home of approximately 20 young adults(Required)

Cooking for other people(Required)

Trying new things(Required)

Being away from your phone(Required)

The Big Picture

Please answer the following question in the space below as best as you are able:

Why would you like to participate in Act Five?(Required)

Tell us about your relationship with God(Required)

The People

Please provide us with a contact who is able to serve as a personal reference for you (please ask this person before including them here).

This should be someone who knows you well and can speak about your faith and character, whether having served as your teacher, coach, youth pastor, camp director, or similar (not a family member). Upon receipt of your application, your reference will receive a separate form from us to complete.

Personal Reference Name(Required)

Personal Reference Relationship(Required)

Personal Reference Email(Required)

Personal Reference Phone(Required)

Please provide an academic reference as well. This should be someone who can speak to your academic experience throughout high school.

Academic Reference Name(Required)

Academic Reference Relationship(Required)

Academic Reference Email(Required)

Academic Reference Phone(Required)

The Final Step

Before you submit this application, here’s your chance to share any final pieces of information with us that you think would be good for us to know.

Share with us

Payment

Good news! You’re applying before the deadline, so you will not be charged an application fee.

Signature

Full Legal Name

Date

MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.

Application form sample

Application Sample

The Basics

The Details

The Big Picture

The People

The Final Step

Payment

Signature

ACT FIVE TURNS FIVE