PVLI APPLICATION

Enrollment:

The PVLI year begins in June and ends in May. Applications for the 2019/2020 ministry year begins January 14 and ends March 31.

Your Name *
Your Name
Phone *
Phone
Address *
Address
Gender *
Birthday *
Birthday
Are you at least 18 years of age? *
Do you understand that PVLI is $750 for one year and can be paid out of pocket or support raised?
Have you ever been convicted of a crime other than a minor traffic violation? *
Do you attend Pleasant Valley? *
References
Please list one personal and one professional reference below:
Name of Personal Reference *
Name of Personal Reference
Phone *
Phone
Name of Professional Reference *
Name of Professional Reference
Phone *
Phone