First Name
Last Name
Preferred Name
Date of Birth
Gender
Male
Female
Phone Number
Email Address
Home Address
Please provide 3 references with names and contact information.
Why would you like to work with City Takers?
What special skills or interests do you have that would support one or more of our mission focuses?
What do you hope to gain from this experience?
Are you aware this is an unpaid 12-month discipleship commitment that requires a minimum of 35 hours a week?
Yes
No
Are you aware this program takes place in Atlanta, GA and you will have to self-fund your stay? Roughly $5,000 for the year?
Yes
No
Are you aware housing will take place in our community apartment and you will likely have 1-3 roommates?
Yes
No
Submit
