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APPLICATION
PRINT THIS APPLICATION AND SEND EVERYTHING AT ONCE. IF YOU
SEND YOUR FIRST PAYMENT OF ONLY $75.00 TOWARD YOUR FIRST COURSE WE WILL SEND THE COURSE MATERIALS WITH YOUR CONTRACT.
Institute Resource Center
P.O. Box 143 Tolar, TX 76476
817-736-3041
APPLICATION
FORM
1. Full Name: (Last)__________________________________________________
(First) __________________________________
(Middle)____________________
2. Residence Address: (No./St.)
____________________________________________________________________
(City) ______________________________________________________________
(State) _____________________________________________________________
(Zip Code) __________________________________________________________
Telephone Residence (_____) _________________________________________
Email Address ______________________________________________________
3. Date of birth _______________________________________ Age __________
Sex: __ Male __ Female S.S.# _______________________________________
4. Spouses Name (If married)
___________________________________________________________________
S.S.
# ______________________________________________________________
5. Diplomas Held:
__ High School
___________________________________________________________________
__ GED
___________________________________________________________________
__ Highest Earned Counseling
Degree
___________________________________________________________________
__ Highest Earned Bible Degree
___________________________________________________________________
__ Highest Earned Other Degree
___________________________________________________________________
6. Your Objectives:
7. Military Experience:
__ Transcripts Enclosed
__ Transcripts will be forwarded within 30 days.
__ Please evaluate for Life Experience Credits (Please include Ministry resume with this form)
If you are
involved in ministry, please use the back of this form to briefly tell us about your ministry (type of ministry, how long
involved, etc.)
___________________________________________________________________
DATE
___________________________________________________________________
APPLICANTS SIGNATURE
EVALUATION FOR: B.Min., M.Min., M.Th., M.C.T., D.Min., D.Th.,
D.C.T. (Circle one)
You may use the back of this form or add another page to complete your answers
This
form may be MAILED to the above address or FAXED
YOU MAY ALSO MAIL THIS AND OTHER
FORMS
TO THE RESOURCE CENTER AT:
AACT University RESOURCE CENTER
P.O. Box 143
Tolar, TX
76476
Fax: See Website Contact Page
Call the Resource Center
Between 9 AM
and 5 PM Monday thru Friday
at 817-736-3041
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