TIAWOM Equipping Center Registration Form

TIAWOM Equipping Center

REGISTRATION FORM
Additional Requirements For Registration

Please keep a copy of this form for your personal records.

Pre-Requisite To Participate In TIAWOM Equipping Center Courses: Completion of new members classes at home church
- Application Form
- Financial Agreement
- Release/Permission Form (from home church)
- Photo for Student File:
- Fees: $300.00 per each 12 week Course*
- Pay all at once or in installments of $25.00 a week.
*$25.00 non-refundable fee due at registration, balance due by the first class.

*All information provided in this form is stricly confidential

THERE IS A WAY OUT MINISTRIES

EQUIPPING CENTER VIRTUAL LEARNING
Email: TIAWOM@gmail.com
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Ethnicity
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Highest Level of Education
Have you previously applied to or attended this school?

YesNo
If yes, what year?
Conversion Date

MonthDayYear
Date
Have You Been Baptized In The Holy Spirit

YesNo
If yes, what year?
Pastor's Name
Church Name
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Number
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name

First NameLast Name
Phone Number
Email
example@example.com