Name 
Address 
City  
State   
Zip  
Phone 
E-mail 

Years in ministry: 
Position: 

Kind of ministerial credentials presently held:


With what organization?:


List past ministry experience:


Present ministry position:


Number of earned credits from Christian Bible school:

From what institution(s)


Number of earned credits from secular college:

From what institution(s)


Remarks:



All students understand that the Academic Prescription they receive from MTC could change as academic dean finalizes a student's enrollment in MTC. Student understands that this form is NOT AN ENROLLMENT FORM for MTC. Costs and credits may vary upon enrollment.