Application Form

Personal Information

Full Name (as displayed on your passport, if you have one)(Required)

First Middle Last

Preferred Name

Gender(Required)

Female

Male

Unspecified

Email(Required)

Contact Phone(Required)

Address(Required)

Street Address City State Postcode Country

Date of Birth(Required)

Date

Month

Year

Country of Birth(Required)

Year of arrival in Australia (if born outside of Australia)

Language spoken at home (other than English)

Citizenship Status(Required)

Is English your first language?(Required)

Yes

Do you identify as Aboriginal and/or Torres Strait Islander?(Required)

Aboriginal

Torres Strait Islander

Both

Neither

Do you have a disability, impairment or long term medical condition which may impact your learning experience?(Required)

Yes

*if YES, we may be in contact to discuss support services and facilities which may assist you.

If under 18 at time of completion name of parent/carer

First Last

Parent/Carer Email(Required)

Details of Emergency Contact

First Last

Emergency contact email(Required)

Phone

I have a current passport(Required)

Yes

If you don’t have a current passport, or your passport expires before December 2025, you will need to apply/renew by the end of March

Passport Number

Expiry Date

I have a current Working With Children Check(Required)

Yes

A WWCC is required for several of our outings, including the Mission Exposure Trip, so if you’re 18 or older and you don’t have one, you will need to apply for one before IMPACT starts

WWCC Number

WWCC Expiry

CHURCH

Name of your church(Required)

Name of Senior Pastor(Required)

Email(Required)

a reference check form will be directed to them

Name of a leader or person who you have a discipleship relationship with(Required)

a reference check form will be directed to them

Email(Required)

How long have you attended this church?(Required)

new – 1 year

1 – 3 years

3 – 5 years

5+ years

Tell us about your experience at your church and any ministries you are a part of:(Required)

EDUCATION INFORMATION

Highest level of education acheived(Required)

RoSA (year 10)

HSC (year 12)

Certificate (TAFE)

Other

That you will have completed at the end of 2023

Name of educational organisation you last studied with(Required)

Year completed(Required)

Australian Tertiary Admission Rank (ATAR) (value will range from 0.05 to 99.95)(Required)

If you do not have an ATAR, or have not received yours yet, please either type NONE or indicate the type of score and your result (eg IB score, A levels score etc)

SPIRITUAL JOURNEY

Can you tell us some of your story with Jesus?(Required)

Can you tell us about your gifts/talents or what ministries you enjoy engaging in?(Required)

IMPACT Gap Year

Which IMPACT format are you applying for?(Required)

Diploma without FEE Help

Diploma with FEE Help

IMPACT Audit

I am unsure and would like assistance in discerning the best option for me

Would you like more info to apply for:(Required)

Accomodation package (pricing TBC)

Scholarship towards my IMPACT cost

Instalment payment plan

Please click any option that applies to you

What are you looking forward to about the IMPACT Gap Year(Required)

Agreement(Required)

I agree

By clicking this box I am submitting the information in this form to the IMPACT team to review. The next stage in this process will involve a personal interview and contact with your church references as listed above. You can expect contact from the IMPACT team in the next 2 weeks to arrange next steps. Please note that the relevant information will be shared with Baptist Mission Australia in preparation for the Mission Exposure Trip. If you have further questions please contact the IMPACT Gap year team via email. impactgap@nswactbaptists.org.au