Study Centre: Study Centre Code No:

Name
 Date of Birth

Age Church Denomination

Years of Experience in Ministry

Your Present Position in Church

PastorEvangelistDeaconTeacherBeliever

Are you married? NoYes

 If yes, spouse name

No of Children

Are you a Divorcee?

NoYes If yes, reason

Permanent Address

Present Address

Nationality

Mother Tongue

Phone (with code)

Cell

Enter the Degree

Email

Educational Qualification Secular

Educational Qualification Theology

Name & Address of Last Institution, you studied

Name of your church Pastor

Your Church Location/ Place

D D Number Bank DD/MO Date

I, hereby, declare that all the information given above are true to the best of my knowledge. I am solely responsible for my Christian life and conduct

Date

Upload Your Signature of the Candidate

Please Attach i) Xerox copies of all certificates and Mark sheets. (if possible, SSLC onwards)
ii) Age proof certificate for the open university candidates. (Birth or Church Certificates)
iii) Brief Testimony of Conversion and Two Photo

Register Number

Remarks if any

ADMISSION GRANTED/REJECTED

Office Seal Date