Online Application for Enrollment
Part 1: Personal
Last Name : First Name: Middle:
Address: (or) P.O. Box:
City : State: Country: Postal Code
Phone : email:
Date of Birth (mm/dd/yy): SSN/SIN #: Sex:
Name of Church: Pastor's Name:
Pastor's Phone Number :
Total years of Christian Service: Types of Service:
Part 2: Credits
Total years of Military Service: Details:
Total classroom hours in attendance of Christian workshops and seminars:
Part 3: Education
Check all that apply
List all colleges, universities, schools, and seminars attend. Include workshops, certificate courses, and other significant
formal training. Submit legible copies of diplomas, certificates, transcripts or other verifiable documenttation of training. Evaluation for credit will be made by the information you supply.
School or College Attended
Location
Dates
Degree/Cert.
Signature: (Checking the circle signifies your signature:
Date Signed: (mm/dd/yy)
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