APPLICATION FOR ENROLLMENT
Please fill in the form completely
Name*
First Name Middle Name Last Name
Gender*
Male Female
NRC#*
Date of Birth*
Month Day Year
Marital Status*
Current Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Home phone*
Area Code Phone Number
Mobile*
Area Code Phone Number
E-mail*
Country of Citizenship*
PROGRAM OF INTEREST
Please select the program you are interested in enrolling in.
Area of Specialization*
Bible Leadership Certification Program Life Coaching Goal Setting Mentoring for Women Adult Literacy Program
Semester*
Spring Summer Fall
RELIGIOUS AFFILIATION
Denomination
Name of Congregation (Leave blank if you do not have a home congregation)
Church Address
Church Phone Number
What is your position in your congregation?
ACADEMIC EXPERIENCE
Highest Level of Education Completed*
List any additional training or certificates you have
Previous Degree Earned*
Bachelors Masters N/A
Previous University Name
Write NA if not applicable
Year (FROM)
Month Day Year
Year (TO)
Month Day Year
PREVIOUS WORK/LIFE EXPERIENCE
List any prior leadership or relevant experience
Name of Business
Write N/A if no prior experience
Year (FROM)
Month Day Year
Year (TO)
Month Day Year
Name of Business
Write N/A if no prior experience
Year (FROM)
Month Day Year
Year (TO)
Month Day Year
STATEMENT OF PURPOSE
Why would you like to enroll into this program
Write a paragraph of why you would like to enroll in your selected program. Explain how it will benefit you, and how you plan to use the skills learned upon completion.*
Use an addition page if necessary.
Statement of Purpose Addendum
If you need additional space you can upload your statement of purpose
LETTER OF RECOMMENDATION
Please submit to letters of reference. One is preferred from your church official or religious mentor. One can be a character reference from a personal contact.
Recommendation letter from a church official*
Recommendation Letter from a character reference*
FINANCIAL RESPONSIBILITY
You will need to complete and sign a separate financial responsibility form.
Method of Payment
I will make payment in full I will need an installment plan I have a sponsor
Attach Documents
Copies of your High school record (All transcripts in single file PDF format)*
Copy of Transcripts from all college/Universities attended (All transcripts in single file PDF format)*
Copy of certificates from training or vocational program (All transcripts in single file PDF format)*
Copy of certificates from training or vocational program (All transcripts in single file PDF format)*
By submitting this application for enrollment, you are confirming it is completed with accuracy. You will be notified of your enrollment status.
If you have questions, please contact Pastor Chinyemba Titus Kamizhi of Access Church, Kabwem Zambia at 260-97-6394202.
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APPLICATION FOR ENROLLMENT

PROGRAM OF INTEREST

RELIGIOUS AFFILIATION

ACADEMIC EXPERIENCE

PREVIOUS WORK/LIFE EXPERIENCE

STATEMENT OF PURPOSE

LETTER OF RECOMMENDATION

FINANCIAL RESPONSIBILITY

Attach Documents