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APPLY ONLINE NOW!!

Please fill in this application completely to be submitted to the Enrollment Administrator's office. Receipt of this application along with your non-refundable student registration fee of $50.00 must be received on or before the first day of class.

The information you provide shall be deemed confidential and stored in a secure and private area per the laws governing such records. The Tuition Amount for this Quarter is $300. Individual classes are $75. If you are unable to pay this amount in full; please contact us to make arrangements for a payment plan.

You may email a recent photo of yourself as well as contact us at ministryschool@abundantharvest.info.

Spring Summer Fall Winter Date:

First Name Last Name Initial

Address City State Zip Code

Social Security No. Date of Birth Phone (Home) Phone (Work)

EDUCATIONAL HISTORY

Schools/ Colleges/ Other	Dates Attended	Graduated	Certificates or Degrees
		Yes No
		Yes No
		Yes No
		Yes No

PROGRAM SELECTION

Degree (Select One)

Associate in Ministry Bachelor of Divinity Master of Divinity Doctor of Divinity Doctor of Philosophy

Major (Select One)

Church Admin. Systematic Theology Biblical Counseling Biblical History

Terminology Pastoral Ministry Hermeneutics Evangelism Hebrew & Greek

CERTIFICATE: Certificates are awarded to those students who are only seeking to enroll in one or two classes during the applicable quarter. Said certificates shall be awarded at the conclusion of that quarter. Please note that the registration fee and tuition fee remains the same for all students.

REGISTRATION FEE AND TUITION

I am paying a $50.00 Registration Fee. I am also paying $ toward my Student Tuition.

Please reserve a place for me. I am paying the Registration Fee and the full Student Tuition.

ABOUT YOUR CHURCH

Please tell us about your affiliation:

With what specific denomination are you presently affiliated?

Baptist C.O.G.I.C. Assemblies of God Methodist Church of Christ

Presbyterian Full Gospel Word of Faith Other

Name of Church:

Address:

Pastor:

Are you currently a member in good standing? Yes No

If No, Explain:

REFERENCE - List the names, addresses and telephone numbers of three persons of whom you may obtain reference letters.

MINISTER

Name:

Address:

City: State: Zip Code:

Phone:

PERSONAL FRIEND

Name:

Address:

City: State: Zip Code:

Phone:

PERSONAL FRIEND

Name:

Address:

City: State: Zip Code:

Phone:

EMERGENCY AND MEDICAL INFORMATION

Please state any medical condition that you may have which could require Harvest School of Ministry Staff to request medical and/or ambulatory assistance on your behalf:

If you are under doctor's care, please list the doctor's name and telephone number below:

Name: Phone No:

Name of Medical Facility:

Address

Do you have medical insurance? Yes No

EMERGENCY CONTACT INFORMATION

In case of emergency, please contact the following persons:

Name: RelationshipStreet Address:

CityState:Zip:Emergency Number:

Name: RelationshipStreet Address:

CityState:Zip:Emergency Number:

MEDICAL CONSENT

I, the undersigned, do hereby grant Harvest School of Ministry Staff the permission and right to render any reasonably necessary, and applicable first aid as warranted in the event of my needing emergency medical attention while on the premises of the same. I also authorize the same to call paramedics or any other licensed ambulatory service for my transportation to the nearest emergency medical facility.

Signature: