Name *

First Name

Last Name

Spouse's Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Gift of Discernment *

Primary Gift

1

2

3

4

5

6

7

8

9

10

Gift of Healing *

Primary Gift

1

2

3

4

5

6

7

8

9

10

Gift of Exhortation *

Primary Gift

1

2

3

4

5

6

7

8

9

10

Gift of Prophecy *

Secondary Gift

1

2

3

4

5

6

7

8

9

10

Gift of Serving *

Secondary Gift

1

2

3

4

5

6

7

8

9

10

Gift of Administration *

Secondary Gift

1

2

3

4

5

6

7

8

9

10

Do you feel called to go onto school after this course to complete a Master’s degree and obtain a license? (If not, that does not affect your acceptance in this program) -- *

Yes

No

Are you ready to commit to both semesters financially and in time commitment (24 weeks, possibly $1200, and many study hours in addition to not missing the 3 hour weekly classes)? *

Yes

No