Please PRINT and complete BOTH PAGES of this application. Thank You! Click here to download this Registration Form as a File (.rtf format) Carolinas School of the Ministry Please PRINT and complete BOTH pages of this form and send it in with your registration fee to ensure your registration. Some of the information below is personal and you may choose to withhold it; but we request it for statistical purposes. None of the information will affect your admission to any programs or your relationship to CSM. Carolinas School of the Ministry seeks to avoid discrimination on the basis of race, color, disability, gender, and national or ethnic origin in the administration of its educational policies, admissions policies, and educational programs. Name__________________________ Age ____________ Phone ___________________ Address ________________________________________ City _________________ State _____ Zip ________ E-mail ________________________ STUDY TRACK: q Elder q Deacon CE q Deacon Music q Deacon Youth q Other ________ MINISTRY GOAL: q Pastor q Evangelist q Music q Youth q Other CULTURE (please check one) NOTE: CSM does not discriminate based on race, gender or age. This information is for statistical data only. q African American q Black, original country: ____________________ q Caucasian q Filipino q Hispanic, original country: ___________________________ q Native American q Asian, original country:_______________________ q Other: ______________________________ Are you currently serving as a pastor or paid staff in a local church? q Yes q No If yes, please circle one of the following: Pastor Associate Youth Music Children Other Marital status ________________________ Number of children living at home ___________ Employer ________________________________________________________________________________ Church Affiliation _________________________________________________________________________ Signed ____________________________________________________ Date _________________________ YOUR REGISTRATION AND PAYMENT MUST BE POSTMARKED BY August 1, 2010 TO RECEIVE YOUR TUITION DISCOUNT
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