In filling out this form, please understand that we have not asked for any information that could typically be used to access any of your personal financial accounts or extremely private information. Criminals are often able to break into your bank and other accounts if they have your date of birth and your social security number (if you are in the U.S.) As you go through this form, you will see that we avoid asking you to reveal any information of this type. FURTHER, Form is for internal Seminary use I understand.
I agree.
Full Name - Title, First, Middle, Last (Jr., Sr., etc.)
Email Address:
Street Number and Name
Box #, if any. If none, "DNA" for "Does Not Apply"
Apartment or Unit #. If none, "DNA" for "Does Not Apply"
Nation (Official or Formal Name of your country - please do not merely use initials)
Is the address above your RESIDENTIAL address where you would receive your diploma and/or other documents? If not, please supply that address here:
Telephone Number (we will not call unless you are an enrolled student who requests specific phone assistance. Our policy is to conduct all communications by email to make it easy to forward from department to department as needed)
Major (#1) - Name of Certification or seminary specialty in which you are enrolled
Major (#3) - Name of Certification or seminary specialty in which you are enrolled
Do you agree that all questions will be answered fully and accurately? Yes
I am over 18 years of age Yes
Do you have a regular income? Yes
Varies (perhaps due to self-employment)
Do you have any credit cards or other "consumer" debt that is past due (or has been during the past four months) Yes
Credit Card Information: If you have credit card debt, (store card debt, etc.) please indicate the approximate current amount:
Motor Vehicle Payments: If you are making contracted payments due to purchasing a motor vehicle, how much is your annual payment commitment for this purpose?
Medical Debt: If you owe medical debt, please estimate the total amount. And, report the annual amount you are paying toward that debt: (If none, enter DNA)
Other Debt (you MAY include alimony and/or child support, although this is neither requested no required by the seminary) (If none, enter DNA):
Number of Dependents who are relying on you for financial support
If you are contributing to the support of dependents, what is the annual amount of these contributions?
Present Employer - Full Company, Agency, Institution, or Individual Name:
Other Liabilities. Please list and report annual payment obligation. (If none, enter DNA)
Employer Phone Number
Employment Status Professional
Full time
Part Time
Unemployed but seeking work
Year and Month Job was Started (if applies). If none, please type DNA
ANNUAL INCOME: Gross salary (Or Total Amount of Money Coming In Annually from Employment, Benefits, etc.)
Other Annual Income and SOURCE (perhaps from Stock Dividends, support from Family, income from Sale of Property, etc.)
Value of Stocks or other Investment held
Home Value:
Residence Status Live in home which I own.
Live in house which I rent.
Rental Apartment
Mobile Home
Live with Friends or Relatives at this time
Live in an institutional setting
Transportation: If you own a car or other motor vehicle, please tell us the Make, Model, Year
SIGNATURE - Please "sign" here. Under current regulations, "electronic signatures" are as acceptable as signatures made with a pen. After you type your FULL NAME, please simply add the initials: L.S. (This simply says that you agree that this is your legal signature. It is signed by you and not by someone else purporting to be you.