Enrollment

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Enrollment

Leadership Training Center Enrollment Application

First name:

Last name:

Email address:

Street address:

Address 2:

City:

State:

ZIP:

Phone:

Cell:

Date of birth:

Gender:

Male
Female

Campus you will attend:

Program of study:

Anticipated start date:

Highest level of education completed:

Explanation, if Other:

Repented?

Yes
No

Baptized in the name of Jesus Christ?

Yes
No

Date baptized:

Recieved Holy Ghost?

Yes
No

Date received:

Minister or ministerial candidate?

Yes
No

Have you ever held license before?

Yes
No

If yes, with whom?

Are you currently licensed?

Yes
No

If yes, with whom?

Level of licensing:

If discontinued, why?

Explain why you wish to study:

Who is your pastor?

What is his email, if available?

Signature of applicant:

Date:

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