The New Geneva Christian Leadership Academy 
 
Advancing the Kingdom of Christ through Scholarship, Leadership and Action


ADMISSION INSTRUCTIONS
Certificate Degree Application
This form can be mailed, or sent as an attachment via email to
Registrar Contact  
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Name: ____________________________________________

Address: __________________________________________

City/County   _________________________  State________ 

Zip_____________                                                                 

Home Phone: ___________________________                        

Cell Phone: _____________________________

Email Address: __________________________

Academic History

Elementary School: ______________________________________

High School: ____________________________________________

If Home Schooled Check Here

Church Affiliation: ________________________________________

Church Address: _________________________________________

City/County: _________________________ State: _____________

Zip: ______________________  Phone: _______________________

Email: _________________ Web Address If any: ________________

Pastor's Name: ___________________________________________

Are you or have you ever been brought under official Ecclesiastic discipline?

___________________

If Yes, explain: ____________________________________________

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Has there been reconciliation? _______________

Areas of Interest and Academic Focus: You can list more than one.

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