1990 N. McCulloch Blvd. Suite D292
Lake Havasu City, Arizona 86403
United States of America
(520) 453-3738
Name ____________________________________________ Birth date___/___/___ Male___Female___
Address_____________________________________________________________________________
(Street, City, State/ Province,Country, Zip/Postal Code
Telephone (____)__________ Have you received Jesus as your savior? _________ Year ____________
Have you received the Baptism of the Holy Spirit? ___________________ Year ____________________
Church _________________________ Address _____________________________________________
Pastor ______________ Telephone (___)_______ Attendance: regular________ irregular __________
Do you feel called to the ministry? ____ If yes, which one? _____________________________________
Do you have a vision? ______ If yes, please explain on back of application.
If you have a current or have had a ministry(s) please summarize those in the back of this application. (Include dates, places and pastor(s) you may have served under)
____________________________________________________________________________________
PLEASE ENROLL ME IN THE FOLLOWING DEGREED PROGRAM:
_____Basic diploma in Biblical studies - one year program
_____Associate of Ministry degree - two year program
_____Advanced Diploma in Ministry - three year program
_____Bachelor of Arts in Ministry - four year program
____________________________________________________________________________________
PLEASE ENROLL ME IN THE FOLLOWING NON-DEGREED PROGRAM:
_____Pastoral Training Certificate
_____Full payment for the first year degreed/Pastoral Training program is enclosed
_____I have enclosed the $10 enrollment fee and the $50 down payment ($100 for Pastoral Training).
NOTE: include a copy of your High School diploma or GED (do not send originals).
IF USING PAYMENT PLAN
I agree to make monthly payments on the 1st____ 15th____ of each month until my balance is paid in full.
