Student Application

Student Application
Name *

First Name Middle Name Last Name
Sex *
Date of Birth *

Month Day Year
US Citizen or Permanent Resident? *
Do you currently reside in the U.S.A? *
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Intended program

Dual enrollment Full time – online academy Part time- online academy
Grade level *
Grade level *
Desired Courses *

Literacy Bible Math
Desired Courses *

Literacy History (First Semester) Science (Second Semester) Bible Math
Desired Courses *

Bible Language Arts Math History Science
Desired Courses *

Bible Language Arts Math Civics Life Science
Desired Courses *

Bible Language Arts Math (Pre-Algebra) Physical Science World Geography
Desired Courses *

Bible English 9 (10-month course) Math History Science Physical Education and Health Finance and Economics
Desired Courses *

Bible English 10 (10-month course) Math History Science Physical Education and Health Finance and Economics Technology
Desired Courses *

Bible English 11 (10-month course) Math History Science Physical Education and Health Finance and Economics Technology
Desired Courses *

Bible English 11 (10-month course) Math History Science Physical Education and Health Finance and Economics Technology
Desired Courses *

Bible English 12 (10-month course) Math History Science Physical Education and Health Finance and Economics Technology
Desired Courses *

Bible English 12 (10-month course) Math History Science Physical Education and Health Finance and Economics Technology
A La Carte *

Art Aviation Bible Business/Economics Church Ministries/ Worship Studies Communications/ Writing Computer Sciences/ Information Studies Counseling/ Psychology/ Sociology Criminal Justice Education English Foreign Language Global Studies/ Ethics/ Western Culture Geography/ Government/ History Health/ Nursing Mathematics Paralegal Studies Science
Associate Tracks *

Interdisciplinary Studies Apologetics Biblical Studies Business Creative Writing Criminal Justice Education History Information Systems Medical Office Assistant (AAS) Military History Paralegal Studies Psychology Religion STEM: Mathematics (AS)
Certificate Tracks *

Application Development Business Administration Database Information Assurance International Business Project Management Web Development Christian Ministry Health Sciences Pre-School
Preferred starting date for course(s) *

Month Day Year
Transcript

(for Full time and Dual enrollment students) Upload up to 5 files
Cancel of
Report Card

(for Full time and Dual enrollment students) Upload up to 5 files
Cancel of
Birth Certificate

(for Full time and Dual enrollment students) Upload up to 5 files
Cancel of
Parent/Guardian Information form

(for Full time and Dual enrollment students) Upload up to 5 files
Cancel of
Confidential Ministry Reference from the pastor of your congregation

(for Full time and Dual enrollment students) Upload up to 5 files
Cancel of
Parent / Guardian Details
Parent / Guardian Name *

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

Application fee $50 per student Non-refundable application fee $50 per student

$ 50.00

Total

$ 0.00

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

Serving Institute Application
Should be Empty:

Student Application

Student Application

Parent / Guardian Details

We would love to hear from you

Get In Touch

Serving Institute