Registration Application Student DetailsFirst Name *Last Name *Social Security Number *Email Address *Phone *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweChurch Affiliation:Name or Church *Pastor's First Name *Pastor's Last Name *Pastor's PhoneCan we contact your pastor?YesNoIf no please explain when is a good time of day to contact you.Positions HeldMinistryAdministrationLaityVolunteer ServiceNumber of Years a memberCurrent StatusActiveInactiveOtherDescribe ResponsibilitiesEmergency ContactEmergency Contact Name *Email Address *Phone *PHONE TYPEMOBILEHOMEEducationEducation BackgroundEducation Background Name of School City/State Did you graduate? (Yes or No) Years left to graduate Date of Graduation Degree received Major Other Credentials / Licenses / Affiliations Skills Course SelectionDegree Level *BachelorMastersDoctorateDegree Program *School of the ApostlesSchool of the Prophet'sSchool of the Pastoral Care and Biblical CounselBiblical StudiesChristian EducationMinistryDetailsPayment InformationCourse Fee$Legal And AuthorizationBACKGROUND CHECK ACKNOWLEDGEMENT SECTION *Understand that I am entitled to a complete and accurate disclosure of the nature and scope of an) investigative report of which I am the subject upon my written request to Elisha Christian University, if such is made within a reasonable time after the date hereof. l also understand that I may receive a written summary of my rights under 15.U.S.C. Section 1681 et. seq. I hereby release Elisha Christina University and any and all persons, business entities and governmental agencies whether public or private, from any and all liability, claims and/or demands by me, my heirs or others making such claim or demand on my behalf, for providing an investigative report hereby authorized. Understand that this Authorization/Release form shall remain in effect for the duration of my association with Elisha Christian University. I, the undersigned, do hereby authorize Elisha Christian University, to procure an investigative report on me that includes social security, verification and criminal history record. I further authorize any person, business entity or governmental agency, who may have information relevant to the above to disclose the same to Elisha Christian University including by not limited to, and and all courts. public agencies, and law enforcement agencies regardless of whether such persons, business entities or governmental agencies compiled information itself or received it from other sources. Consent *Confirm that all information provided is accurate and you agree to the terms.Radio (Payment Method)StripePayPalPayment PlanSignature *Start signing your signature hereYour browser does not support e-Signature field.Submit enrollment