MODS99

Children: No. of your own (if any): No. you care for:

Give the name, address and phone number (if applicable) of two personal references. They should be good standing people in the community (well known i.e. Pastor, L.C., Business leader, etc) and they should know you personally. We may contact them for information about you. It is preferable to list people who have a phone as this speeds up your application process.

Name, Position, Address and Phone Number:

1. _________________________________
   _________________________________
   _________________________________
   _________________________________

2. _________________________________
   _________________________________
   _________________________________
   _________________________________

Your e-mail address:

Occupation and Skills

What is your current form of employment?

__________________________________________________________________________

What other skills do you know?

__________________________________________________________________________

Which Programs of Study do you intend to use to get your award?

*Residential

*Non Residential

Spiritual Information

1. Home Church Name:

Home Church Address:

Pastors Name:

Denominational Affiliation (Tick One):

PENTECOSTAL

METHODIST

ANGLICAN

BAPTIST

PRESBYTERIAN

OTHERS

Address: PO Box 2560, Kampala, Uganda    Phone: (041) 530-524    Email: admin.gtbc@gladtidingsbc.org