Patmos: Reality Discipleship Application

1.General Information

Greetings in the Name of Jesus!

We are so excited about your decision to apply to Patmos: Reality Discipleship. Your adventure begins here as we work together to seek God's purpose and plan for this next season of your life. We are praying for you, and we look forward to seeing whether God has Patmos: Reality Discipleship as a part of His plan for you.

Revelation 1:9,
Patmos: Reality Discipleship

1.First and Last Name(Required.)

2.Gender(Required.)

Male

Female

3.Date of Birth(Required.)

4.Phone Number(Required.)

5.Email Address(Required.)

6.Mailing Address (Address, City, State, Zip Code) (Required.)

7.Church/Denomination (Required.)

8.How did you hear about or who recommended you to Patmos: Reality Discipleship?(Required.)

9.What term are you interested in?(Required.)

The next one offered (Date TBD)

Other

10.Do you have a passport (Must be valid for 6 months after the term end date)

Yes

No

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