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
