UAFWBBC Association Extension Organizations Program Application Form
Institutional Data
Name of Institution
*
Phone Number
*
Please enter a valid phone number.
Street Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Website
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Names of Officers
Chief Executive Officer
*
First Name
Last Name
Chief Academic Officer
*
First Name
Last Name
Chief Financial Officer
*
First Name
Last Name
Registrar
*
First Name
Last Name
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Name of the Board Chair
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
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Describe your Institutional Characteristics in terms of: 1. Academic Calendar, e.g., semester breaks, etc. _____________________________________________ 2. Off-Campus Locations (name, city, state/province) (see definitions); List offerings, credentials (if applicable) [Attach separate sheet if necessary]
Branch Campuses
*
Additional Locations
*
Extension Classes
*
Distance Education (Method: i.e., correspondence, online)
*
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Control Affiliation
Give the name of the denomination by which your institution is controlled or to which it is closely affiliated. If none, write “independent.” b. If independent, identify the theological perspective to which your institution adheres, e.g., Baptist, Wesleyan. If course work is taught from an interdenominational perspective, write “interdenominational” or “nondenominational.”
Input Control Affiliation Info Here
College Courses to be taught other than UAFWBBC
*
Degrees, Diplomas, Certificates Requested (See current Residential Course Catalog)
Number of Student Ready to Enroll / Participate
*
Number of Students
Associate Degree
Bachelor Degree
Master Degree
I hereby certify that, to the best of my knowledge, the above information is correct.
Signature, Chief Executive Officer
*
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Application Fee
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$
500.00
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