APPLY: Adult Learners

Online Jerusalem & Athens January Seminar

The information provided on this application will permit the administrative staff of the Center for Faith & Inquiry and the Studio for Art, Faith & History better to understand the clientele interested in the Seminar, and to create efficient means of sharing information about the Seminar with applicants.

Please fill out the application form below with your information. Email john.skillen@gordon.edu or call 978-867-4592 if you have any questions.

1. Date of Application:

2. Last Name:

3. First Name:

4. Middle Name:

5. Gender:

Male
Female

6. Date of Birth:

7. Place of Birth:

8. Country of Citizenship:

9. Valid Passport:

Yes
No
Not necessary for my program

10. If yes, what is the expiration date on your passport? (Your passport should be valid for at least six months after the Jerusalem & Athens January Seminar.)

11. Full Name exactly as it appears on passport:

12. Email address:

13. Mailing Address:

14. Cell Phone Number:

15. Emergency Contact -- Last Name, First Name, Phone and Address:

16. This Seminar includes activities that require moderate to challenging physical exertion. Do you have any chronic physical conditions that require regular medical attention or that may be relevant for consideration in a program that requires physical activity such as walking, hiking, caving, etc.? If so, please explain.

17. Do you have allergies to foods, plants, etc.? Are there any prescription or non-prescription medications that you take regularly that you would anticipate needing while you are attending this program?

18. Do you have any learning disabilities you would like the program faculty to be aware of? If so, what?

19. What is your relation to Gordon College?

Alum of Gordon College
Alum of the Gordon IN Orvieto Semester program
Parent of Gordon student
Regular attendee of Center for Faith & Inquiry events
Friend of the Gordon IN Orvieto Semester program
Friend of the Studio for Art, Faith & History
Financial supporter of the College
Other

20. Highest degree earned; from what institution?

21. What has attracted you about this Seminar?

22. Say something, if your wish, about your vocational experience and/or personal interests.

23. How do you imagine that this Seminar (especially with its topic of the virtues of individual character and civic duty) might enrich your personal life and equip you for more astute engagement in your family, your workplace, your church community, or your social circles?