ADMISSION INSTRUCTIONS
Doctoral Degree of Applied Theology
Application
Th.d.

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Name: ____________________________________________

Address: __________________________________________

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Home Phone: ___________________________                        

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Email Address: __________________________

Academic History  & Degrees ______________________________

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Church Affiliation: ________________________________________

If you are a Pastor, Elder or Deacon please verify

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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?

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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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Degree Program Sought

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