Kingdom Shifters Wellness University Admissions Form

Kingdom Shifters Wellness University Admissions Form

Please fill out the application form carefully and with as much detail as possible. The benefit of joining KSWU is that you are able to receive discounts on books and certification courses. You are also able to work towards completing licensing for the Kingdom Wellness Counseling and Mentoring Theory and other licenses we will off in the Apostolic, Destiny, and Wellness.
Personal Information
Full Name

First NameLast Name
Birth Date

MonthDayYear
Age
E-mail
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your time zone?
Martial Status

SingleMarriedDivorcedWidowed
Occupation
Employer
Emergency Contact: Please list name, phone, and address
Education Background

List your previous schools, beginning with the most recent

Form collapse ender
Certifications/ Licensing

Please list any certification or Licensing that you have received.
Name of Institution 1
Certification/Licensing Specialty
Certification or Licensing Date

MonthDayYear
Date
Expiration Date if one is listed

MonthDayYear
Name of Institution 2
Certification/Licensing Specialty
Certification or Licensing Date

MonthDayYear
Expiration Date if one is listed

MonthDayYear
Name of Institution 3
Certification/Licensing Specialty
Certification or Licensing Date

MonthDayYear
Expiration Date if one is listed

Current Certification and Course Programs

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