MSOM New Student Enrollment Form

Student's Full Name*

First NameLast Name

Date of Birth*

MaleFemale

Mailing Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Testing Location (If you have questions about your testing location, please call our office at 417-881-1316)*

Cape: Bethel Assembly of God; 1855 Perryville Rd, Cape Girardeau, MO 63701Kansas City: Evangel Church; 1414 103rd St, Kansas City, MO 64131Rolla: First Assembly of God Church; 1608 N Oak St, Rolla, MO 65401Springfield: SOMO District Office; 528 W Battlefield Rd, Springfield, MO 65807St. Peters: First Assembly Church; 4750 N. Service Rd, Saint Peters, MO 63376

Enrollment Fee*

New Student Enrollment Fee

$50.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

DISCLAIMER

The Missouri School of Ministry (MSOM) provides the coursework necessary to fulfill the educational requirements for credentials with the Assemblies of God (AG). However, completing these courses alone does not guarantee qualification for AG credentials. Additional steps, including background checks, references, credit reports, and other evaluations, are required.

If you or your spouse has been divorced and a former spouse is still living, this may affect your eligibility for credentials. Before registering with MSOM, please contact the Network Credentialing Officer, Marte Becker, at executivesecretaryassistant@somoag.org, to discuss your situation if obtaining AG credentials is your goal.