SALT MIT Program Application Form

SALT MIT Student Application
This application will not be processed until all supporting forms and payments are received in our office.

Referrals: Your application will not be complete until we receive both a Personal and a Minister’s Referral for you.
Application Guidance

1. We encourage you to apply early to help secure your place in the course.

2. We recommend that you allow about 30 minutes to complete the application form.

3. Please answer all applicable questions.

4. Use the digital signature pads to sign all forms.
Campus Location*
Term*
Class Availability*
PERSONAL DETAILS
Name*

TitleFirst NameSurname
Address*

Street Address

Street Address Line 2

TownState

PostcodeCountry
Mobile Phone*

Country CodePhone Number
Email Address*
example@example.com
Gender*
Age*
Date of Birth*
Date of Birth

MonthDayYear
Date
Marital Status*
What is your first language?
What year were you baptized in the Holy Spirit?
PERSONAL REFERRAL

All applicants must have a Personal Referral on file. You may choose anyone who is not a family member. The referral will be filled out by your referee privately, and submitted directly to SALT MIT Admissions.
Name of Referee for Personal Referral*

TitleFirst NameSurname
Email Address of Referee*
example@example.com
Phone Number*

Area CodePhone Number
MINISTER'S REFERRAL

All applicants must have a Minister’s Referral on file, which is to be completed by the Pastor of your church, or a ministry leader of which you are affiliated. The referral will be filled out by your referee privately, and submitted directly to SALT MIT Admissions.
Name of Referee for Minister's Referral*

TitleFirst NameSurname
Email Address of Referee*
example@example.com
Phone Number*

Area CodePhone Number
CHURCH AFFILIATION
Where are you currently attending a local church, if not, explain.
Church Name
Pastor's Name

TitleFirst NameSurname
How long have you been attending this church?
Please list any current or past church activities you have been involved in.
What is your position in your local church?
EDUCATIONAL HISTORY
What is the highest level of education you have obtained?*
Please Specify degrees, etc.
Please list schools that you have attended.*
EMPLOYMENT HISTORY
Please list your present work experiences.*
HEALTH CONCERNS
Do you have any medical challenges? If yes please explain:
Please list the person to notify in case of emergency:*

First NameSurname
Emergency Contact's Phone Number*

Country CodePhone Number
CONSENT
I, the undersigned, grant full and complete permission to SALT MIT/SALTCWC, its employees or designated, or any related or consulting physician to render or give emergency medical aid, care, treatment, or assistance that could or would be deemed required or necessary. This consent I give freely and voluntarily, fully knowing and understanding all the above and its effect upon me.*

Clear
Please sign in the box.
Date*

YearMonthDay
Date
I, the undersigned, grant full and complete permission to SALT MIT/SALTCWC, its employees or any persons they choose, to take, keep on file and use in publications and on social media platforms, any photos, video recordings or audio recordings of me while involved in any SALT MIT associated event including both class and non-class times.*

Clear
Please sign in the box.
Date*

YearMonthDay
Date
I hereby state that all the information contained on this application is correct and true. If SALT MIT is notified that any of the information contained on the application is false, it will be grounds for immediate dismissal.*

Clear
Please sign in the box.
Date*

YearMonthDay
Date
TESTIMONY
Personal Testimony*

0/400
Upon acceptance into our SALT MIT program, I understand that all information contained in this application will be kept as part of my permanent file, and will be shared with SALT MIT Course affiliates to include SALTCWC. I consent to this and affix my signature.*

Clear
Sign in the box.
Date*

YearMonthDay
Today's Date
Current SALT MIT StudentSALT MIT Brochure/AdvertSocial Media (Facebook, Instagram, etc...)Former SALT MIT StudentSALT websiteOther
Please specify other:
REQUIRED APPLICATION FEE
A non-refundable Application Fee of $25.00 must be paid before you submit your application (application fee will be applied to tuition upon acceptance).

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Non-Refundable Application Fee$25.00

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An interview may be requested as a part of your application process. A completed application and application fee does not guarantee acceptance. If you have any questions, please email us at life@saltcwc.com.
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SALT MIT Student Application

PERSONAL DETAILS

PERSONAL REFERRAL

MINISTER'S REFERRAL

CHURCH AFFILIATION

EDUCATIONAL HISTORY

EMPLOYMENT HISTORY

HEALTH CONCERNS

CONSENT

TESTIMONY

REQUIRED APPLICATION FEE