Certificate Program Application

Complete and submit the information below and we will contact you to schedule an interview.

First Name

Last Name

Preferred Name

Date of Birth

Confirm Email

Phone

Address

City

State

Zip Code

Do you regularly attend Church on the Move?

COTM Campus

If not COTM, which church?

If COTM, use N/A

Area of Internship Interest

Social Media Handles

Please list your social media handles. Instagram, Snapchat, Facebook, etc.

T-Shirt Size

Questions?