SVCM Bible School Registration

Saved Victorious Christian Ministry Inc.

Bible School Registration
Information shared on this form will be held confidential.
PERSONAL INFORMATION
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Application*

MonthDayYear
Date
Date of Birth*

MonthDayYear
Date
Gender*
CHURCH MEMBERSHIP INFORMATION
NAME OF THE CHURCH YOU ATTEND*
ADDRESS OF THE CHURCH YOU ATTEND*
PASTOR'S NAME*
PASTOR'S PHONE NUMBER*
YEAR(S) OF YOUR SALVATION*
EDUCATION HISTORY
YEAR(S) IN MINISTRY*
AREA OF ACADEMIC PURSUIT*

Education History*

	Name of School	City, Country	Certificate/Degree Earned	Year(s) of Attendance
#1
#2
#3
#4

What level of certification are you interested in earning upon completion?*
Would you like to work with the ministry after completing your studies? If yes, in what capacity? (optional)
Payment Plan Certificate (26 weeks). Please note that the payment plan start date for the certificate begins on the date of registration.*

Weekly - $38 (21 Weeks)Monthly - $130 (6 months)Full Payment - $780
Payment Plan Degree (optional)

Full payment - $3,9202 installments - $1,960 weekly5 installments - $784 weekly8 installments - $490 weekly14 installments - $280 weekly21 installments - $187 weekly
Payment Plan Degree Start Date (optional)

MonthDayYear
Date
OTHER INFORMATION
Emergency Contact Full Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Do you have any medical conditions? If yes, please explain.*
Agreement

By signing this form, you agree to complete all the courses in your program of choice and to make full payment to be eligible for graduation and to receive a certificate or degree. You also understand that failure to make payment based on this agreement will result in delay and inadmissibility to classes until payment is made (3 days grace period is offered after each due date). I also understand that payments which are made towards any certificate or degree program will not be refunded.

Registration

Product Name

$150.00 Quantity
Item subtotal:$0.00

CertificateYou will receive a certificate of completion for any program that you choose. You will be able to make additional payments and complete additional review sessions if you would like to receive a Bachelor of Arts degree for your particular program. The total cost is $780. Please select your payment option below.

$130.00 QuantityPayment Options
Item subtotal:$0.00

Degree You will receive a Bachelor of Arts degree based on the certificate course that you have completed. The total cost is $3,920. Please select your payment option below.

$3,920.00 QuantityPayment Options
Item subtotal:$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Saved Victorious Christian Ministry Inc.

PERSONAL INFORMATION

CHURCH MEMBERSHIP INFORMATION

EDUCATION HISTORY

OTHER INFORMATION

Agreement