Application for Study

ALPHA INSTITUTE OF MINISTRY




Name: _________________________________________________________________________________

Street Address: __________________________________________________________________________

_______________________________________________________________________________________

Home Phone: ____________________________________________________________________________

Work Phone: _________________________________ Cell: _______________________________________

E-mail: __________________________________________________________________________________

Web site or Face Book: ____________________________________________________________________

Date of Birth (d/m/y) ______/_______/___________ Gender: F_____ M______

Country of Residence: _____________________________________________________________________

Area of Study
[ ] 1-Year Certificate in Christian Service
[ ] 2-Year Diploma in Christian Service & General Ministry
[ ] Advanced Qualification in Biblical Study


FINANCIAL AID
Do you seek Financial Aid? Yes No
Do you seek a Y.E.S. Grant or Loan? Yes No

Note: Alpha Institute of Ministry does not discriminate on the basis of race, color, sex, age, religion, marital status,
disability, national or ethnic origin, or socio-economic status.

EDUCATION:
What is your highest level of education? _______________________________________________________

List below the last schools attended:

SCHOOL LOCATION DATE QUALIFICATIONS

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________



EMPLOYMENT EXPERIENCE: List last three positions: (Start with current)


DATES EMPLOYER/ADDRESS POSITION

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

REFERENCES: References are required as part of the admission process. Please give names and
complete addresses of references.

Professional/Education Reference:

________________________________________________________________________________________

________________________________________________________________________________________

Character Reference

________________________________________________________________________________________

________________________________________________________________________________________






____________________________________

Signature of Applicant



Remember to sign your printed application form. Submit $100 application fee and mail to:

Attn. Helen Desaine
Office of the Registrar
Alpha Institute of Ministry
LP#4 Bedessie Street
St Augustine, Trinidad & Tobago