ASOM Online Application

Address

Phone Number *

- Area Code Phone Number
E-mail
Facebook Info
Birth Date

Month Day Year
Age
Church you attend
Marriage Status
Pastor's Name
Medical Background
Have you every used illegal drugs?
Date last used

- Month - Day Year
Have you every used tobacco?
Date last used

- Month - Day Year
Have you ever consumed alcohol?
Date last used

- Month - Day Year
Employment History
Present Employer
Postion & Date Hired
Past Employer
Postion & Date Hired
Select one
Course Payment Plan (Courses must be paid in full before receiving access to online course.)
How do you plan to pay for your course?
Church History
Church Name
Pastor's Name

First Name Last Name
Phone Number

- Area Code Phone Number
E-mail

Address

How long have you attended this church?
What ministries are you involved in?
Are you a member of this church?
When did you accept Christ? Where?
Have you been baptized with water?
Have you had an Acts 2:4 experience?
How many times a week do you attend church? Where?
References: (Must include a pastor as a reference) [Name. Relation. Phone Number]
What is your definition of church?
General Questions
How did you hear about ASOM?
What shirt size are you? (We are sending you a T-Shirt)
I HAVE HONESTLY COMPLETED THIS APPLICATION FORM AND HAVE ANSWERED THE QUESTIONS TO THE BEST OF MY ABILITY AND if accepted, I agree to take full responsibility of paying the total tuition. I understand that I am responsible for the vehicle, if I choose to bring one, including maintenance, insurance, etc. I agree to provide a current DMV record, proof of insurance, and a copy of my driver’s license. I agree to cover all expenses and damages if I am borrowing a vehicle and have an accident or receive a citation.
Signature
Date

- Month - Day Year
Please tell us your testimony in 100 words or more.
Should be Empty:

ASOM ONLINE APPLICATION