Name: _____________________________________________________
     Last        First        Middle

__________________________ Nickname

____     ____ male     female

Marital Status: ___single___engaged___married___separated___divorce
(not a basis for acceptance or rejection)

Spouse or fiance(e) name: _____________________________________

Ethnic heritage: _____________________________________________
(not a basis for acceptance or rejection)

Your birthdate: _________________

Place of birth: ________________

E-mail address: _________________________________________________

How did you hear of OUP?






Address during school year

__________________________________
street or box

__________________________________
city, state, zip or postal code

________________________        (___)____________
country, if outside U.S.        telephone number

____ this is campus/university housing

Don't send mail here after _____________
               Month/Day/Year


Permanent address

__________________________________
street or box

__________________________________
city, state, zip or postal code

________________________        (___)____________
country, if outside U.S.        telephone number

_____ this is my parents'address

Use this address beginning ____________
               Month/Day/Year

Will you return to your school address next fall? No___ Yes ___

If yes, approximate date _______________


Academic Information

School: ____________________________

__ college/university	__ Bible college/seminary
__ voc/business school	__ Jr./community college
__ High school

Highest level of attendance: ____________

Graduation date: _____________________

Major: ________________


Temporary Address (if different from above):

__________________________________
Street or box

_____________________________________________
city, state, zip or postal code

________________________        (___)____________
country, if outside U.S.        telephone number

Use this address from _______ to _______


I am a citizen of: _______________
If applicable, type and expiration date of visa: _______________________________

visa # _________________________________

Your local church name: ________________________________

Senior Pastor: ___________________

Denomination: _____________

Are there any medical problems which prevent you from engaging in rigorous activity? __ no __ yes

If yes, please describe:

1. How and when did you become a Christian?








2. What is your current involvement in evangelism? Be specific.

a. Have you had specific training in evangelism? If so, please describe.







b. Give a brief statement or outline of your understanding of God's plan of Salvation.

a. If an InterVarsity student, what IV training events have you attended and what leadership positions have you held?

a. What experience have you had in urban/cross-cultural relationships? (e.g. previous
travel or residence overseas or in an urban community, involvement with students from
other countries or ethnic groups, etc.)








b. Why do you want to come to OUP this summer?

10. How do you feel about following directions from a small group leader?








11. Give a recent example of a conflict with an authority person or peer. How did you
deal with those conflicts?








12. What do you see as your strengths?








13. What do you see as your weaknesses?








14. Additional comments:

1. Fill out this application and return it with a $75.00 non-refundable
application fee. After May 1, add a $25.00 late fee. Make checks payable to
Kim Koi. Send these application materials to:

Orlando Urban Plunge
338 E. Lyman Ave.
Winter Park, FL 32789
Phone: 407/647-3413, ext. 325
Fax: 407/647-2406

a. IV Staff Worker ________________________        Phone: _____________________
(or equivalent Christian leader)

b. Roommate or peer ______________________        Phone: _____________________

Physical limitations (if any, including allergies, medications, etc.)







Are you covered by a major medical insurance policy (over $50,000)?
___ yes ___ no

Insurance agency: ____________________________

Policy #: _______________________________

In case of emergency, contact:

______________________________________________________
Name               Relationship

______________________________________________________
Address

______________________________________________________
City/State/Zip               Phone Number

Has this person accepted your involvement in this program? ___ yes ___ no