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Enrollment Form

Master of Theology (M.Th) CHRISTIAN COUNSELING
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First Name:
Middle Name:
Last Name:
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Personal Reference Name/Phone:
Name of our student who referred you
or Scholarship Cert. # if any:
Date of Birth:
Degree Program or Certificate:
Do you have High School Diploma or GED? YES  NO
For graduate studies do you have a Bachelor's Degree? YES  NO
By clicking the "Send Enrollment" button below,
I hereby certify that all the information I have given is accurate to the best of my knowledge.
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Please READ the Student Agreement Here