Revive This Nation

Application for

Revive This Nation

For questions or assistance with this application, please contact

Student Services at (817) 923-1921 ext. 7300 or e-mail .

Are you applying as a repeating participant or as a new participant?

New Repeating

BASIC INFO:

FULL NAME:

(Exactly as it appears on your driver license or

other government-issued photo identification):

Preferred Name:

Southwestern ID Number:

SouthwesternE-mail Address:

Other E-mail Address:

Date of Birth

Marital Status: (Choose only one)

Never Married Married Widowed

Divorced Separated Divorced/Remarried

EDUCATION:

In what school are you currently enrolled at SWBTS?

School of Theology School of Evangelism and Missions

School of Church and Family Ministries School of Church Music

The College at Southwestern

If a graduate student, from what college did you graduate?

Name

City, State

OTHER:

Are you a fluent English speaker who is able to engage in a fluid, unrehearsed conversation and preach a sermon in English?

Yes No

Do you want to travel by personal automobile to your church field instead of taking an airline flight? Travel expenses will be paid by Southwestern at the rate of the lesser amount of airfare or mileage basis.

Yes No

If married, are you interested in having your wife accompany you to the church field? You will be responsible for making and paying for travel arrangements for your wife.

Yes No

Please indicate your regional preferences by selecting all that apply below. Students are expected to serve wherever they may be assigned, and should not apply unless they are willing to do so, but serious consideration will be given to the regional preferences of students within the limitations of the program strategies and available churches.

No Preference

North-Atlantic US: New England, New York, New Jersey, Pennsylvania, Maryland,

Delaware, Washington D.C., West Virginia

Midwest US: Ohio, Indiana, Illinois, Michigan, Wisconsin, Dakotas, Nebraska,

Kansas, Minnesota, Iowa, Missouri

Northwest US: Washington, Oregon, Idaho, Montana, Wyoming

Southeast US: Alabama, Arkansas, Georgia, Florida, Louisiana, North Carolina,

South Carolina, Tennessee, Kentucky, Mississippi, Virginia

Southwest US: California, Nevada, Utah, Colorado, Arizona, New Mexico,

Texas, Oklahoma

Eastern Canada: Quebec, Ontario

Western Canada: Manitoba, Saskatchewan, Alberta, British Columbia

Revive This Nation Commitment

I commit to:

Fulfill all assignment offered, with the understanding that I may not be consulted before being assigned to a church.

Notify Student Services immediately by or calling (817) 923-1921 (ext. 7300)in the event that I should become unavailable or unable to fulfill any events to which I have committed myself aboveso that airline tickets will not be purchased for me.

Reimburse Southwestern for the cost of my airline ticket in the event that I should become unavailable for any event to which I have committed myself if an airline ticket has already been purchased for me.

Search the Scriptures daily in personal devotion so that I might know Him better and communicate the Gospel of Jesus Christ more effectively.

Walk in a manner that is pleasing to the Lord in personal holiness by repenting of all known sin, forsaking questionable activities and striving toward the example of Jesus Christ.

Engage in purposeful prayer for the church and the lost community to which I am assigned so that God might break my heart for them and grant me a burning desire to preach the Gospel.

Proclaim the Gospel in personal evangelism to advance the cause of the Great Commission wherever the Lord places me.

I (name) commit to do these so that God may use me to His great ends.