Course Registration Form

Student Registration Form

Fill out the form carefully for registration
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
Phone Number
Do You Have A Personal Relationship With Jesus Christ?
Church Membership
The name of your local Church
Pastor’s Name
Pastor’s Contact
Email Address
How did you hear about Alive University?
How will you be attending Alive University?
Choose one
In what Area(s) Are You Actively Serving in Your Local Church? If not, state your reason(s) why.
Please provide two personal (non family member) recommendations for your enrollment at Alive University.
Please provide full name, phone number, and email
ALL TUITION AND FEES ARE NON-REFUNDABLE
Should be Empty:

Student Registration Form