APPLICATION FOR ADMISSION

Bishop, Dr. James E. Streeter, Founder & President

Personal Information

Last Name

First Name

Middle Initial

Home Phone

Work Phone

Cell Phone

Social Security #

Date of Birth

Sex

Marital Status

Place of Birth (City & State)

Name of Spouse

Mailing Address

City

State

Zip Code

Email Address

Program of Desired Enrollment

Degree Level of Enrollment

Background Information

Present Occupation

Employer

Name of Local Church

Church City

State

Zip Code

Pastor's Name

Pastor Contact Phone

Are you a minister?

Licensed?

Ordained?

Years in full-time service

Denomination / Organization

Reference (Relative/Friend)

Relationship

Reference Address

Citizenship

Country of Birth

U.S. Citizen?

Permanent U.S. Resident?

Alien Registration #

Do you have a U.S. Visa?

Visa Type

Expiration Date

Education Information

High School Information

Name of High School

City

County

State

Date of Graduation

College History (List All Colleges)

Institution Name

City

State

Dates Attended (From - To)

Degrees Received

Hours Earned

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- All monies received for Scholarships will be awarded to underprivileged students for furthering their education.

- Our scholarships ….. thus far / testimonials

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APPLICATION FOR ADMISSION

Bishop, Dr. James E. Streeter, Founder & President

High School Information

College History (List All Colleges)