Enrollment Application Form

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I am applying for the following program:

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone - Mobile*

Phone - Home

Phone - Work

Fax

Marital Status

Married

Unmarried

Divorced

Spouse's Name

Present Occupation:

How long at this occupation?

Employer:

Your approval to contact your employer:

Yes

Employer's email:

Employer's phone:

Employer's address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Year you graduated high school:

Year you graduated college:

Name of academic institution:

How many years have you been a Christian?

Are you an ordained minister?

Your denominational preference?

Name of your local church:

Pastor's name:

First Last

Your approval to contact your pastor:

Yes

Pastor's email:

Pastor's phone:

Pastor's address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Friend or relative's name:

First Last

Your approval to contact your friend or relative:

Yes

Friend or relative's email:

Friend or relative's phone:

Friend or relative's address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you become aware of Abundant Life Christian Counseling Services and Training Center?

Biblical Creation Therapy Training Program Down Payment

Price:

A non-refundable down payment of $250 is required along with an agreement to pay the balance of $630 in three monthly installments of $210 + $7.00 convenience fee, which is due and payable monthly (automatic credit or debit card deduction) when applying for enrollment in the Creation Therapy Training Program.

Certified Pastoral Counselor Program Enrollment Application Deposit

Price:

A $100 non-refundable fee is due when applying for enrollment in the Certified Pastoral Counselor Program.

Certified Temperament Counselor Program Application Enrollment Deposit

Price:

A $100 non-refundable fee is due when applying for enrollment in the Certified Temperament Counselor Program.

B.A. Degree Program Enrollment Application Deposit

Price:

A $100 non-refundable fee is due when applying for enrollment in the B.A. Degree Program.

Masters Degree Program Enrollment Application Deposit

Price:

A $200 non-refundable fee is due when applying for enrollment in the Masters Degree Program.

Ph.D. Program Enrollment Application Deposit

Price:

A $300 non-refundable fee is due when applying for enrollment in the Ph.D. Program.

Licensure & Second Doctorate Program Enrollment Application Deposit

Price:

A $300 non-refundable fee is due when applying for enrollment in the Licensure & Second Doctorate Program.

Credit Card

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