Palmetto Genesis – Application General InformationName:(Required) First Last Preferred Name (if different from above)Email:(Required) Cell Phone:(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Gender(Required) Male Female Age(Required)Please enter a number from 0 to 25.What grade are you going into?(Required) 9th Grade 10th Grade 11th Grade 12th Grade Are you a member of an SC Southern Baptist Church?(Required) Yes No Not a member, but a regularly involved attendee If so, Which SC Southern Baptist Church?(Required)When did you become a disciple of Jesus?(Required)When were you baptized by immersion?(Required)Tell us about how you came to believe in Jesus and how your life has changed since then.(Required)Why do you want to be a part of Palmetto Genesis?(Required)Information for ReferencesApproval into Palmetto Genesis is subject to both a parental and pastoral/ministry reference. The people that you list below will be sent an email with instructions to complete an approval/recommendation form on your behalf. Please notify these individuals that they will be receiving an email from SCBaptist with the required form.Parent/Guardian Name(Required) First Last Parent/Guardian Phone Number(Required)Parent/Guardian Email(Required) Pastoral/Ministry Reference Name(Required) First Last Pastoral/Ministry Reference Phone(Required)Pastoral/Ministry Reference Email(Required) I acknowledge that if I am accepted into Palmetto Genesis, there will be a $200 fee per semester.(Required) I understand CAPTCHA
