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         Higher Learning College of Theology -  Registration Form:
Full Name:    Title:
Address:          City:    State:    Zip Code:
Phone:            Cell Phone:     Work Phone:
Social Security Number:     Date of Birth:     Sex:  male    female
Maritial Status: M  S  D W                  Place of Birth:
Name of Spouse:  Mailing Address:
E-Mail Address:  
Program of Desired Enrollment:   Degree Level: Associates   Bachelors   Masters   Doctorate
____________________________________________________________________________________________________________________________
 
                                     Background Information: This information taken is better to serve you as a student
 
Occupation:      Employer   
Name of Local Church    Pastor’s Name   Contact Phone  
Address / City / State / Zip   
Are you a minister? Y or N    Licensed? Y or N    Ordained? Y or N    Other :  
How long have you been in Full Time Service? Yrs  Months
To what denomination or organization do you belong or classify yourself?  
Reference:   Relationship: Address/City/State/Zip:
 
Ethnic Origin: This information is required by the Civil Rights Act
 Caucasian  Black-not Hispanic   Asian Pacific Islander  Hispanic   American Indian/Alaskan    Other  
 Citizenship:   Country of Birth:    Are you a citizen of the USA?  Y or N
     If No, please answer the following:  Are you a permanent resident alien?  Y or N   Alien Registration #
     Do you presently have a U.S. Visa?  Y or N   If yes, what type?      Expiration Date 
 
Education
 High School     City/State    Country     
       Date of Graduation:   If you did not graduate, did you receive a GED?  Y or N  When?
 
List all colleges attended in chronological order:  (latest first)
Name of Institution   City/State 
Graduation dates:     Degree received: 
Hours earned Semester   Quarter
__________________________________________________________________________
 
Name of Institution   City/State 
Graduation dates:     Degree received:
Hours earned Semester   Quarter
__________________________________________________________________________
 
Name of Institution   City/State 
Graduation dates:     Degree received:
Hours earned Semester     Quarter
__________________________________________________________________________
Are you currently enrolled in the last institution attended?  Y or  N   If so, what is your last date of attendance
Are you eligible for readmission to any of the institutions listed? Y or N  If no, please explain
Have you been convicted for violation of Federal, State, County or municipal law?  Y or N    If yes, Please explain in detail
I have completed this application to the best of my ability and have been truthful to the best of my knowledge in answering all questions. I do hereby
agree to abide by the high ethical standards set forth by Higher Learning COT-SEP and to conduct myself in the accordance to the expectation of
Higher Learning COT-SEP in order for my life to bring glory and honor to the Lord Jesus Christ.
 
I have read the Statement of Faith of Higher Learning C.O.T. and agree to follow the doctrinal stand in accordance with the Word of God.  
                    Full Name:   Date:       


      Click the button below to make your secure payment using PayPal for the $40.00 Non-Refundable Application Fee.
               Payment must be made before we can process your Application Form, God Bless You and Thank-You.

                                                    
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