5K2C Phase 2 Application

Name_______________________________________________________
Address (if applicable)_________________________________________
____________________________________________________________
City_________________________State_________Zip Code___________
Phone(

)______-_______ Date of Birth_________________________

Email address________________________________________________
Social Media
Facebook ID_________________________________________________
Twitter_______________________ Instagram______________________
Other________________________ Other__________________________
Education
High School_________________________________________________
Graduated? Yes_______ No________ if no, last grade completed_____
College_____________________________________________________
Graduated? Yes_______ No________ if no, credit hours completed_____
Trade School________________________________________________
Graduated? Yes_______ No________
Other education_____________________________________________
Last Job held_______________________How long employed___________
Legal Past

Have you ever been convicted of a crime?__________

Active Warrants?__________ A yes answer does not disqualify you by any means
List Offenses and sentence on reverse side of this page
Religious background and preferences
What Faith do you practice?_____________________________________________
Why do you practice that Faith?
____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Reality Show Questionaire
1. Are you willing to commit to the topics of this program with an open but
questioning state of mind? ______________________________________________
2. Are you willing to be an active participant of this Program?
_____________________________________________________________________
3. Are you willing to sign a release and allow yourself to be filmed during your
evolution in order to give guidance in practical application to our brothers and
sisters still on the street?____________________________________________

Essay Question (seperate sheets of paper)

If money was no object, what do you feel intuitively led to contribute and
serve,
to not only your personal growth but also to society and humanity, to who you

truly are? Please meditate and/or pray on this question. Be led by the heart and
not by the mind.

Everything on this application is true and correct to the best of my knowledge

Signature_________________________________________________________
Printed name______________________________________________________
Date__________________________
Best way to contact you_____________________________________________