Enroll | Education & Clergy Development

* Required Field

Student Information

First *

Middle *

Last *

Maiden

Nickname

Title

Suffix

Gender *

Date of Birth *
/ /
Month Day Year

SSN

Married
Yes

Preferred Language of Study

Contact Information

Phone (Home) *

Phone (Work)

Phone (Cell)

Email (Primary) *

Email (Secondary)

Mailing Address

Country *

Address 1 *

Address 2

City *

State *

Zip *

Zip 4

Residential Address ( Same As Mailing Address )

Country *

Address 1 *

Address 2

City *

State *

Zip *

Zip 4

Education

Highest Level of Education *
No High School Diploma or GED (probationary status)
Graduated High School
Some College
College Graduate
Some Seminary
Seminary Graduate

Purpose For Enrollment

Enrollment Track *

Attending Church At *

Current Position (Pastor, Asst. Pastor, Lay Worker, etc.) *

Form Fee

A $20.00 fee is required for this enrollment to be processed.

Payment Method *

Billing Address On Credit Card Statement ( Same As Mailing Address )

Country *

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Zip 4

Release Permission

I hereby grant permission to The Wesleyan Church Education and Clergy Development Division to release any records of my work or personal information for the purpose of informing the General Church, its district leaders, or its boards concerning my progress in and completion of the course requirements and other data as needed.

Signature of Student *
Please type your full legal name: Enrollment Date: 05/30/2017

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