[ ] Mr. [ ] Mrs. [ ] Miss [ ] Rev. [ ] Dr. [ ]
Evang.
Social Security Number _______________________________
Name
_____________________________________________________________________________________________________________
(Last) (First) (Middle) (Maiden)
Mailing Address
_____________________________________________________________________________________________________
City
_________________________________________________State__________________________
ZIP____________________________
Telephone including Area Code (Day)
__________________________________________
(Evening)__________________________________
E-Mail Address
______________________________________________________________________________________________________
I plan to attend: [ ] Fall [ ] Winter [ ] Spring [ ]
Summer Year
________________________________________________________________
PROGRAM OF STUDY: [ ] Advanced Certificate of
Theology (11 courses, 33 semester hours) OR
[ ] Diploma in Theological Studies (22 courses, 66
semester hours) OR [ ] Audit Individual Courses
PERSONAL DATA: If you are a U.S. citizen, what is
your legal state of residence?
_______________________________________________
If you are not a U.S. citizen, what is your nationality?
________________________________________________________________________
Type of Resident: [ ] U. S. Citizen [ ] Student Visa [ ]
Visitor Visa [ ] Immigrant Visa (Permanent Resident
National Origin: [ ] Cauc. American [ ] Hispanic [ ]
Asian or Pacific [ ] Black American [ ] American Indian [ ]
Foreign or Other
DATE OF BIRTH: _____________________________________ AGE:
______ SEX: [ ] Male [ ] Female
MARITAL STATUS: [ ] Never Married [ ] Widowed [ ]
Divorced [ ] Separated [ ] Married [ ] Remarried
If Married, Spouse's Name:
_____________________________________________Spouse's
Occupation _____________________________________
CHURCH AFFILIATION:
__________________________________________________________________________________________________
Denomination/Church Affiliation/Name of Your Local Church
________________________________________________________________________
Do you attend regularly? [ ] Yes [ ] No Are you a member
? [ ] Yes [ ] No
FAMILY INFORMATION: Names and ages of all
children. (Please include adult children).
________________________________________________________________________________________________
________________________________________________________________________________________________
EDUCATIONAL SUMMARY: High School Attended
____________________________________________________
Location _____________________________________Year of
Graduation ________________Approx. GPA ________
GED? _____________Where taken?
______________________________Year Received
_________________________
College [ ] None [ ] Some Name of College/University
________________________________________________
Location ___________________________________________Major
_____________________Degree Received ______
Year of Graduation _____________ Hours Taken
___________________________GPA _________________________
Name of College/University
__________________________________________________________________________
Location ______________________________________Major
____________________Degree Received ____________
Year of Graduation _____________ Hours Taken
___________________________GPA _________________________
(List additional college information on separate paper).
EMPLOYMENT HISTORY: Please use the space below to
list in chronological order, beginning with the most recent
employment. Include dates and your positions.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
REFERENCES:
Clergy Reference:
________________________________________________________________________________________________
(Name of Minister) (Address) (Telephone Number)
Personal Reference:
________________________________________________________________________________________________
(Name) (Relationship) (Address) (Telephone Number)
Professional Reference:
________________________________________________________________________________________________
(Name ) (Relationship) (Address) (Telephone Number)
HONORS AND ACTIVITIES: Please list below in order
of importance extracurricular activities, offices held,
accomplishments, professional memberships, prizes, honors
and scholarships received since high school.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Please list your activities and participation in the
local church or in ministry.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
PERSONAL SKETCH: This a Christian institution
designed to serve the body of Christ. With this thought in
mind, on separate paper write one or two pages about
yourself and include the following information. (1) A
statement on why you desire to attend this school and how it
relates to your life goals. (2) A description of your own
religious experience, past and present. (3) Major events and
traumas in your life (death, divorce, career change, etc.)
(4) A statement on your call to the ministry or vision for
ministry in the local church or beyond. How will you benefit
from this program? Type or write legibly.
THE CODE OF HONOR PLEDGE
In signing the Code of Honor, I fully recognize that
these two institutions were found to be and are committed to
being Christian religious ministries and that they offer a
lifestyle of commitment to Jesus Christ of Nazareth as
personal Savior and Lord as an integral part of their
evangelistic outreach. It is therefore my personal
commitment to be a person of integrity in my attitude and
respect for what these schools are in their calling to be
Christian institutions.
I PLEDGE to apply myself wholeheartedly to my
intellectual pursuits and to use the full powers of my mind
for the glory of God.
I PLEDGE to grow in my spirit, developing my own
relationship with God.
I PLEDGE to cultivate good relationships socially with
others and to seek to love others as I love myself. I will
not lie, I will not steal, I will not curse, I will not be a
talebearer.
I PLEDGE to keep my total being under subjection from all
immoral and illegal acts and habits, whether on or off
campus. To this end, I will not take any illegal drug. I
will not commit illicit sexual acts, including homosexual
behavior. I will not drink alcoholic beverages of any kind.
I will not use tobacco. I will not engage in other behavior
that is contrary to the rules and regulations listed in the
student handbook.
I PLEDGE to maintain an integrity to "openness" to God's
claim on my life, and to do my utmost to know and follow His
will for my life.
I PLEDGE to attend class the house of worship of my
choice wherever God is honored and lifted up.
I PLEDGE to abide by the rules and regulations that may
from time to time be adopted by the Administration. I
understand that these institutions are private schools, and
I have no vested rights in the governance of them. I accept
my attendance as a PRIVILEGE and NOT a right and that these
institutions reserve the right to require the withdrawal of
a student at any time if in the judgment of the President of
either institution or of the Discipline Committee such
action is deemed necessary to safeguard the schools' ideals
of scholarship or the spiritual and moral atmosphere of them
as Christian institutions. I will keep the HONOR CODE
carefully and prayerfully. I understand that my signature
below is my acceptance of the entire Code of Honor and
completes a contract between the school and me which is a
prerequisite for matriculating and become a part of my
permanent file.
Signature______________________________________________________
Date_____________________________
Print full
name___________________________________________________________________________________
(Return this application with a $35.00 application fee
to: The Way of Life Spiritual Development Center, P. O. Box
13373, Richmond, VA 23225
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