Discipleship Course(s)
APPLICATION: CERTIFICATE IN CHURCH LEADERSHIP AND MINISTRY
(Advanced Discipleship Course)
Discipleship Course/Audit students
(Please keep a copy of this application in your computer files)
Studying at Annesbrook Leadership College is guaranteed to be a life-changing experience. ALC is concerned
with establishing students professionally by teaching every leadership skill and attitude required regardless
of future career intentions.
Leaders have natural skills, but developing those skills calls for a choice to place oneself under the care and
direction of experienced and qualified people whose only desire in life is to see others succeed in realising
their full potential. ALC is dedicated to providing the environment and the tools to develop leaders of
integrity in a Christian context. As you complete this application form begin to develop a sense of
expectation and excitement.
You are embarking on a journey of growth and you will bless others both in the process and when you have
completed your study. Make sure your application form is completed and returned with your application fee
no later than January 22, 2016. We are looking forward with anticipation to meeting you and serving to build
your life.
APPLICANT CHECKLIST – please ensure all of these are included.
□ Application Form
□ Pastoral Reference (All courses)
□ Personal Reference (Advanced Discipleship only)
□ Application Fee of $100 (non-refundable)
Intensive Discipleship/Audit Students choose courses (cross out which does not apply):
□Leadership Cert/Dip
□Spiritual Growth Cert/ Dip
□World View (certificate)
□Biblical Interpretation (Diploma)
□Theology Cert/Dip
Payment Methods (Circle which course you are applying for)
Fees for 2015 are:
$2288 + $100 application fee (Advanced Discipleship Course)
$850.00 + $100.00 Application fee (Discipleship Course)
$100 per term (Audit)
Eftpos: Come into the Annesbrook Church office during business hours (9-5 Monday – Thursday).
Cheque: Make cheque for $100 payable to ‘Annesbrook Church of Christ’ (Send cheque with this application)
Credit card (circle one):
Mastercard
Visa
Amex
Card Number: …………………………………………………………………………….. Expiry Date ___/___
Name on Card: ……………………………………………………………………………… Signature: ……………………………………………….
Direct Payment: May be paid into any branch of the National Bank, or on line as a one off payment:
Account Number 06-0705-0049218-00
Use your last name followed by ALC fees as reference (e.g. “BrownALCfees”).
Mail your application to:
Annesbrook Leadership College
PO Box 2184
Stoke, Nelson
You may deliver your application to the Annesbrook Reception, 40 Saxton Road, Stoke, Nelson
APPLICATION INFORMATION
Name: …………………………………………………………………………………………………………………………………………………………
Address: …………………………………………………………………………………………………………………………………………………………
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Post Code ……………………………….
Email:
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Birth Date dd/mm/yyyy: ………../…………/………………......
Phone Home: (………)………………………………………..
Mobile: ………………………………………………………
Home Church: ………………………………………………………………………………………………………………………………….
Senior Pastor Name: …………………………………………………. Phone: (………)…………………………………………….
Who do we contact in case of an emergency?
Name: ………………………………………………………………………………………….
Phone: (………)…………………………………………….
Mobile: (………)…………………………………………….
Email: …………………………………………………………
Relationship to Applicant: ………………………………………………………….
List any food allergies you suffer from (Important for Orientation camp)
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How did you hear about Annesbrook Leadership College? …………………………………………………………………………
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How do you anticipate paying your ALC fees? ……………………………………………………………………………………………
Please note we do not accept weekly or monthly Automatic Payments. If you can’t pay the full fee by a
method listed above at the beginning of the year please contact the dean at alc@annesbrook.co.nz
Is your family supportive of your application to study at ALC? (circle)
Y/N
What are some of your interests? What do you enjoy doing in your free time?
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MINISTRY EXPERIENCE
What ministry experience (if any) have you had, and what form did it take?
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What do you consider to be your strengths and weaknesses?
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EDUCATION AND WORK EXPERIENCE
Education history
Name of
school(s)/institution(s):……………………………………………………………………………………………………………………………………
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Dates attended: …………………………………………………………………………………………………………………………………………….
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Qualification(s) earned: …………………………………………………………………………………………………………………………………
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Employment history
Place(s) of employment in the last 3 years:
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Dates employed: ……………………………………………………………………………………………………………………………………………
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Type of work: …………………………………………………………………………………………………………………………………………………
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PRACTICAL MINISTRY ASSIGNMENT (Advanced Discipleship only))
All students are required to complete up to 13 hours of internship (plus class room time) per week. An
Internship Management Scheme (IMS) has been developed to ensure full benefit to the student is derived
from this part of the course. Please indicate on the list below what areas of interest you may have for
service.
□ Administration
□ Crèche 1 – 3yrs
□ Children 3 – 6yrs
□ Youth 13 – 18yrs
□ Dance
□ Design/media
□ Teams
□ Women
□ Young Adults
□ Worship
□ Other (Please specify; e.g. “My home Church rather than the ALC IMS”) ……………………………………………………
…………………………………………………………………………………………………………………………………………………………………………
If you prefer to work in community or business environments please state so in the “other” section.
(Note: Any Internship work done under the “other” section will still require verification under the ALC IMS
programme)
MENTORING REQUIREMENTS (Advanced Discipleship Only)
All ALC students are required to have a mentor who has committed to meet with them regularly for the
full length of the College year. Mentors, once identified, will be required to undergo a training session.
Mentors are people you trust with confidences, conflicts, and the triumphs as well. Your mentor will be your
principle personal support person throughout your ALC experience. All students are required to meet with
their mentor twice a month, and your mentor will provide regular and confidential reports regarding those
meetings. The ALC team will work together with your mentor to ensure that you are doing well and your
needs are being met competently and compassionately.
The mentor you choose should be:
- Someone with significantly more life experience than you
- Preferably the same gender as you (though this is not mandatory)
- A mature Christian
- Someone that you are able to trust implicitly
Please explain the requirements to your mentor and fill in their contact information below. We will
contact them directly.
MENTOR CONTACT INFORMATION
Mentor’s Name: ………………………………………………………………………………………………………………………………………………
Postal Address: ………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………… Post Code……………………
Email: ……………………………………………………………………………………………………………………………………………………………
Home phone: (………)…………………………………………….
Mobile:
(………)…………………………………………….
What Church do they attend?: ………………………………………………………………………………………………………………………
Role in your life (e.g. friend)
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PASTORAL REFERENCE
(All Courses)
(These two pages to be completed by a pastor or senior leader who knows you well and personally)
Name of Applicant:
Address:
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Post Code …………………………
Dear Referee
Please fill out this form and return it in a sealed envelope to:
Annesbrook Leadership College
PO Box 2184
Stoke, Nelson
Please respond to the following questions honestly. Your responses will be kept confidential.
If there is a question you do not feel able to comment on, please indicate with N/A.
It is not appropriate for a relative to complete this reference. If the applicant is related to the Pastor,
another Church leader may complete this form.
Referee Details:
Name:
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Position:
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Church / Ministry:
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Email:
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Phone Work:
(………)…………………………………………….
Mobile:
(………)…………………………………………….
Postal Address: ……………………………………………………………………………………………………………………………………………….
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How long have you known the applicant?
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How well would you say you know the applicant?
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Do you recommend the applicant commencing study with ALC?
Please discuss reservations (if any):
Post Code …………..…………………………
Y/N
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Has the applicant shown signs of growing Christian maturity? Yes/No
Please describe:
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Comment on any strengths or spiritual gifts you observe in the applicant:……………………………………………………..
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Comment on any weaknesses or areas of struggle that you observe in the applicant: ……………………………………
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Are there any further comments you wish to make?
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Thank you for your contribution.
This document is important for the Board of Reference when considering the application. Other than the
Board of Reference, there will be no other persons to whom this information is available.
PERSONAL REFERENCE
(Advanced Discipleship and NZQA Courses)
(To be completed by someone who has known the applicant for at least two years and who is not related
to the applicant)
Name of Applicant:
…………………………………………………………………………………………………………………………………..
Address:
…………………………………………………………………………………………………………………………………..
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Post Code ………………………………………
Dear Referee
Please fill out this form and return it in a sealed envelope to:
Annesbrook Leadership College
PO Box 2184
Stoke, Nelson
Please respond to the following questions honestly. Your responses will be kept confidential.
If there is a question you do not feel able to comment on, please indicate with N/A.
Referee Details:
Name: …………………………………………………………………………………………………………………………………………………………….
Email: …………………………………………………………………………………………………………………………………………………………….
Phone Work:
(………)…………………………………………….
Mobile:
(………)…………………………………………….
Postal Address: ……………………………………………………………………………………………………………………………………………….
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How long have you known the applicant?:
Post Code ………………………….
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How well would you say you know the applicant?:
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Do you recommend the applicant beginning study with ALC? Yes/No
If you have reservations please discuss them here:
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Do you see evidence of Christian character development in the life of the applicant?
Yes/No
What are the strengths and weaknesses that you see in the applicant? ..........................................................
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Are there any further comments you wish to make?
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Thank you for your contribution.
This document is important for the Board of Reference when considering the application. Other than the
Board of Reference, there will be no other persons to whom this information is available.