Midwest College Application
Name
First Name
Last Name
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Marital Status
Please Select
Single
Married
Divorce
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Please Select
Male
Femail
Date of Birth
-
Month
-
Day
Year
Date
BACKGROUND INFORMATION
Information taken to better serve you as a student
Name of Church Hosting School
Host Pastor's Name
Host Pastor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name of High School
Did You Graduate or Obtain a GED?
Please Select
Yes
No
GED
Graduation or GED Date
-
Month
-
Day
Year
Date
High School Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select your preferred degree
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Associate Core Curriculum
$
80.00
Bachelors Core Curriculum
$
90.00
Masters Core Curriculum
$
100.00
Doctorate Core Curriculum
$
120.00
I have read the Statement of Faith of the Midwest College of Theology and agree to follow its doctrinal stand in accordance to the Word of God.
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