Enrollment Application

Welcome future student.  Pray, then please help us get to know you by completing this free, confidential application.

Full Name
Address 1
Address 2
Zip/Postal Code
E-Mail Address

Home Phone Date of Birth  
Cell Phone Gender Male Female  
Fax Number Marital Status  

High School Diploma Awarded By: Year & Major  
Associates Degree Awarded By: Year & Major  
Bachelors Degree Awarded By: Year & Major  
Masters Degree Awarded By: Year & Major  
Doctoral Degree Awarded By: Year & Major  

The date you became a Christian
Do you hold ministerial credentials?
If credentialed, when & by whom ?
Church Member?  Church Name: 
Do You Have A Felony Conviction? If so, describe below.
Spouse's Name (if applicable)
Your Current Occupation
Applying To Which Program :

Why do you want to become a counselor?

How do you know you were called into the counseling ministry?

Your remarks, questions, suggestions or anything else we should know...

Are you ready to begin?