Major   Graduation Year 2008 2009 2010 2011 2012 2013 2014

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Please select your preferred method for us to communicate with you: US Mail Web/E-mail

General Health Excellent Good Fair
Please describe any significant health concerns (diabetes, asthma, high blood pressure, etc.):

Have you had professional counseling within the last two years? No Yes
If so, when and for what purpose?

Which Stu Mo Staff person do you know best: xMacie Ayersx xJordan Ayersx xKyle Baackx xTracy Baackx xKelby Bealex xStephen Billingsx xSarah Billingsx xDanica Brownx xBetsy Brownleex xBlake Brewerx xMark Carterx xBlake Chrismanx xStephen Clickx xLacey Clickx xKristyn Erstenuikx xChyla Eusterx xMegan Fitzgeraldx xDagan Flowersx xKrista Flowersx xHeather Gansonx xRoderick Handsx xBob Harrisonx xAlissa Harrisonx xBrittan Heatlyx xAngela Hessx xBrett Heidebrechtx xClaire Heidebrechtx xJoe Huffx xM-Hodgex xJoel Johnsonx xJen Johnsonx xJason Kuhlmanx xNate Lawx xHeather Lawx xClaire Lewisx xMeredith McWilliamsx xAmanda Morrowx xBrent Orrx xJessica Orrx xMatt Pacex xJenna Parkerx xJohn Petersx xAshley Petersx xGreg Piercex xShannon Piercex xDanny Pointsx xHailey Pointsx xBrandon Rietzx xKimber Rietzx xDave Rinerx xErin Scogginsx xJason Soderstromx xMolly Soderstromx xSteve Shadrachx xCarol Shadrachx xTed Shimerx xAmber Shimerx xEliie Shoupx xBryan Smithx xAshley Smithx xKevin T-mannx xStephanie T-mannx xSean Vollendorfx xKim Vollendorfx xBrittany Williamsx xTonya Zunighax

Stu Mo Staff person or spiritual leader submitting reference form:

1. Describe how you came to know Christ personally (please include age, if possible):

2. Kaleo is designed to help you grow spiritually in the five areas listed below. What are some ways you have been able to grow in these areas already?

Obedience to Christ:

God's Word:

Prayer:

Time Spent with Other Christians:

Witnessing for Christ:

3. How long have you been growing in your relationship with Christ? less than 6 months 6 months to a year more than a year

4. How have you been involved with Student Mobilization (check all that apply):
Attend large group meeting
Investigative Bible Study member
Investigative Bible Study leader
Vision Group member
Vision Group leader
Discipleship Group member
Discipleship Group leader
Campus Retreat
Christmas Conference
Kaleo
Other:

5. Is there someone on your campus who has been helping you grow spiritually? Yes No
If yes, who?

6. What church do you attend?
In what ways have you been involved with them?
(For example- attend Sunday worship, college class, Sunday School teacher, work in nursery, etc.)

7. What do your parents think about your participation in this project? Very Excited OK Have Questions No Opinion Strongly Against

If your parents would like more information, please Click Here.

8. I have read the Kaleo Unifiers and will follow them at the project if accepted. Yes No

9. Is there anything at all that would keep you from starting the project on May 21st and completing your commitment through July 24th? Yes No

If yes, please explain. You must receive permission from the project leadership to come late or leavve the project before it is over. Excused absences include weddings (actually in the wedding party) and mandatory school functions.

10. Write a brief summary of why you feel the Lord is leading you to apply to Kaleo.

11. Do you understand that the financial savings you take home will depend on your specific job, project fees, your own spending habits and how much support you raise? Yes No

12. Do you understand that your application does not guarantee acceptance. We only have a limited number of spots avaliable and those accepted who return a $250 non-refundable deposit will be guaranteed. Deadline for deposit is April 2. Yes No

MAKE SURE YOU GET A THANK YOU SCREEN AFTER YOU SUBMIT. OTHERWISE YOU MAY NOT HAVE TRULY SUBMITTED!