We are excited that you have decided to start an application to Act Five's gap year program! If you have any questions during this process, don't hesitate to contact us


Your Address


Your Contact Information


Current / Most Recent Schoool


Courses Completed in Most Recent / Current School Year
Please make a list of your courses with their full name and course code



Indicate below how comfortable you are with the following activities, with 1 being "not comfortable at all" and 5 being "very comfortable".

The Big Picture

Please answer the following question in the space below as best as you are able

The People

Personal Reference

Please provide us with a contact who is able to serve as a personal reference for you (please ask this person before including them here).

This should be someone who knows you well and can speak about your faith and character, whether having served as your teacher, coach, youth pastor, camp director, or similar (not a family member). Upon receipt of your application, your reference will receive a separate form from us to complete.


Academic Reference

Please provide an academic reference as well. This should be someone who can speak to your academic experience throughout high school.

Before you submit this application, here's your chance to share any final pieces of information with us that you think would be good for us to know.


Signature