Enrollment Information


Program Applying for:

 Military & Law Enforcement Chaplain

 EMS Outreach Chaplain

 Biblical Studies

 Missions

 Church Administration

 Single Course


Biographical Information


First Name   Last Name   Middle Name


Permanent Address   City, State, ZIP


Email Address   Phone Number   Skype


Date of Birth   Place of Birth   Citizenship


Gender   Marital Status   Name of Spouse


Number of Children   Home Church   Pastor's Name


Church Address   City, State, ZIP   Phone


If you are seeking College Credit, is your Pastor willing to work with you to accomplish your tests?

 Yes    No    Not Seeking Credit


Is your family in agreement with your educational desires?

 Yes    No


If no, please submit details:



Have you ever been arrested?

 Yes    No


If yes, please submit details:



Parent/Next of Kin   Relationship


Address   City, State, ZIP   Phone


How do you intend to finance your education?:

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