Residential Application

Please fill out application, print, then mail to :
Manager
Winifred Stuart Mankowski Homes
819 North Citrus Avenue, Azusa, CA 91702

If you are concerned that you may not meet the qualifications please fill out our preliminary application. We will contact you to schedule a personal interview to gather further information.

Page: 123456
A
Date
Your name in full

Your complete address

City State Zip
Telephone Number SSN
B
Your date of birth Age Sex
Birthplace Of which country are you a citizen?
If your citizenship is other than the United States, are you able to obtain a permanent United States resident visa? (Please type yes / no or Don't know)
Are you married, widowed, divorced or single?
C
How long have you been practicing Christian Science?
How long have you served actively as a Christian Science Journal listed practitioner, or as a
Christian Science Journal listed nurse? List years
Does your listing appear now? Yes No
If your listing in The Journal has ever withdrawn and removed, kindly explain fully :
When did you receive Christian Science primary class instruction ?
Who was your Christian Science primary class teacher? , C.S.B
When did you first join the Mother Church, The First Church of Christ , Science in Boston, Massachusetts? (please enter year)
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