Course Registration Form

Student Registration Form

Fill out the form carefully for admission into CWSM
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Home Phone
Work Number
Church Affiliation*
Are you currently in ministry
Course you wish to take*
Additional Comments
Should be Empty: