Emerson Theological Institute - Application for Student Enrollment

Emerson Theological Institute PO Box 2127 Oakhurst, CA 93644 Phone: 559-642-4616 Fax: 559-683-2748 email: emerson@sti.net Application for Student Enrollment Please print, complete and mail this form along with supporting documentation and fees to the above address
Sponsoring Center (if known)
Date:
Your Name:
Mailing Address:
City, State, Zip Code/Postal:
Country:

Day Phone:
Evening Phone:
Email Address:
Enrollment Program: (circle one)	I request enrollment in the following program: ___ Bachelor of Religious Studies ___ Master of Religious Studies ___ Doctor of Religious Studies ___ Doctor of Spiritual Studies ___ Doctor of Divinity ___ Practitioner Credential ___ Interfaith Minister Credential ___ Religious Science Minister Credential
High School Attended :
High School Location: (city, state)	Graduated? Yes No
College Attended:
College Location:
College Major:	Major: _______________________________ Graduated? Yes No Degree:______________________________ Please check those that apply below: ___ I wish to transfer college credits (See Enrollment for details) ___ I include transcripts, certificates of completion, copies of diplomas/degrees and other documentation with this application. (See Enrollment for details) ___ I will send transcripts, certificates of completion, copies of diplomas/ degrees and other documentation later. (See Enrollment for details)
Registration Fees:	$100 for each degree program or credential program $50 - first time enrollment fee ___ Check enclosed for $______ (made payable to Emerson Institute) ___ Credit card payment of $_______ _____Visa _____ MasterCard _____American Express Card Number: _____________________ Expiration Date: _____________ Enrollee's Signature: __________________________________________ Date: __________________________
In the right hand column, please write a statement about credit you desire for previous study. Also list any supporting documentation you are sending via snail mail. If you need more room, please use the reverse side of the form.