Ministers For Christ Outreach
Bible Institute
PMB 107
6630 West Cactus ~ Suite B107 ~ Glendale, Arizona 85304 ~ USA
Phone (623)-334-3421
We are on the World Wide Web: ~ http://www.ordination.org
ENROLLMENT APPLICATION
Name _________________________________
Title: _________________________________
Mr. [ ]
Miss [ ]
Mrs. [ ]
Dr. [ ]
Rev. [ ]
Personal Information
Date of Birth:__________________
Male [ ] Female [ ]
Indicate your present marital status:
Single [ ]
Married [ ]
Widow or widower [ ]
Divorced [ ]
Divorced and remarried [ ]
If married, name of wife or husband:_______________
Number of Children? ____________
Minister Yes [ ] No [ ] Ordained Yes [ ] No [ ]
Permanent Address:
Street: __________________________________
City: _______________________
State: __________ Country____________Zip______
Country of citizenship:________________________
Country of birth: ____________________________
Telephone: __(____)-___________________
Page 1
Mailing Address (Same as Above? Yes )Yes [ ] No [ ]
Street: _______________________________________
City: ____________________________
State: _________________Country_______Zip_______
Is your permanent home address different from the one
you are presently using? Yes [ ] No [ ]
Parents or Guardians Information:
Name ___________________________________
Address______________________________
City__________________________
State_________________Country__________Zip______
Telephone
Church Information
Where is your church membership:
(if none, N/A)
Location_________________________________
Pastors Name_____________________________
Telephone________________________________
Christian Work:
What Christian work have you done?________________
____________________________________________
_____________________________________________
Can use additional sheet and attach as ‘Exhibit A’
Enrollment Information
Indicate when you plan to begin your studies:
Fall [ ]
Spring [ ]
Summer [ ]
Winter [ ]
Indicate the year: _____________
Page 2.
Applying for field of study:
Christian Worker's Diploma 354.00 [ ]
Ordination 413.00 [ ]
Were you ever expelled or denied admission by any
school?
Yes [ ] No [ ]
If "yes", explain:__________________________
_______________________________________
_______________________________________
_______________________________________
College Information
Give the name and location of Universities, Colleges, or
Bible Institutes you are now attending or have attended:
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
References:
Please give us the names of two references you would
like us to use:
Pastor's name: ___________________________________
Telephone: _________________________________
Reference Name: ________________________________
Telephone: ________________________________
Reference Name: _______________________________
Telephone: _______________________________
Page 3.
III. Personal Health
Do you know of any serious condition in your present
health that would be detrimental to your schooling causing
delay in your studies?
Yes [ ] No [ ]
Who is responsible for your account?
Self [ ]
Mother [ ]
Father [ ]
Guardian [ ]
Other___________________________
If other, give complete name and address of person to
whom the statement should be sent:
Name: ___________________________________________
Street:________________________________________
City: _________________________________________
State:_____________ Country:___________Zip:_______
Telephone:_____________________________________
"I certify that the information given on this
application form is complete and accurate. I also
understand that I am financially responsible for the
payment of this account if the student listed on this
application is accepted for enrollment."
Date:__________________________
Check here if you agree: [ ]
Foreign Students must make a full payment at
registration plus additional 12.5% for overseas postage.
Pledge
I BELIEVE the Bible as the fully inspired Word of God; I
accept its teachings as the final authority in all
matters of faith and life. This pledge indicates that I
if I am accepted as a student, I pledge to help
maintain the high moral and spiritual ideals of the
Church, render due respect to those who are in
authority, and fully conform to all the regulations of
the Church.
I accept the Pledge [ ]
I do not accept the Pledge [ ]
Page 4.
Application Procedure:
Please send us a snapshot of yourself along with the $20
application fee necessary to process your application.
Ministers for Christ Outreach, PMB 107, 6630 W. Cactus,
Suite B107, Glendale, AZ 85304 USA
"If the foundations be destroyed, what can the righteous
do?" (Psalms 11:3)
If you have any questions for the Admissions Office, call (623)-334-3421
CREDIT CARD INFORMATION
(the following information is not needed if paying by check or Money Ordr)
Name of Person Ordering___________________________________________
E-mail address (if any)________________@___________._______
Card Type Visa______ MasterCard______ Card Number________________
Expiration date (Month/Year) _______/_______
Dollar Amount of Order $______________
Name that appears on Credit Card_____________________________________
Address of Card Holder_____________________________
City of Card Holder________________ State/Province of Card Holder_________
Country of Card Holder_________ Zip code of Card Holder_______________
Phone Number of Card Holder (___)_____________
Signature of Card Holder__________________________________
Page 5.