APPLICATION FOR ADMISSION

Reynolds Institute For Pastoral Education & Development

Center for Education in Ministry

This form must be filled out the first time you register for a course. Application fee is $50.00

Please complete ALL information.

Social Security # _______ _______ _______

NAME:_______________________________________________________________________

Last First Middle Maiden

ADDRESS: _____________________________________ PHONE:( ____)_________________

CITY: ______________________________________ STATE: _______ ZIP _______________

E-MAIL ADDRESS: __________________________________________

Birth Date _______________________ Ethnic/Cultural Group (Optional) __________________

Church Name ___________________________________ Denomination __________________

Full Church Address:____________________________________________________________

Pastor's Name: ___________________________________ Phone: ( ____)_________________

Field of Study Goals: Check area of study

ELDER TRACK -BIBLICAL STUDIES

DEACON TRACK -CHRISTIAN EDUCATION

DEACON TRACK -COMPASSIONATE MINISTRY

LAY MINISTRIES

AUDIT ONLY or PERSONAL ENRICHMENT

Are you a:

Locally Licenced Minister

District Licenced Minister

Ordained Elder

District_______________________ Date first Licensed _____________

Year Graduated from High School ___________ or obtained GED ____________.

List all colleges, universities, and community colleges attended.

Name of Institution City State Dates attended Degree

1. _________________ _________________ ______ From ______________ to ____________

2. _________________ _________________ ______ From ______________ to ____________

3. _________________ _________________ ______ From ______________ to ____________

4. _________________ _________________ ______ From ______________ to ____________

Contact in case of an emergency: Phone (____) _________________________

Name: ___________________________ Address: _____________________________________

State________ Zip____________ Relationship:_______________________________________

I hereby give the director of the Reynolds Institute; Center for Education in Ministry permission to share my academic information with the New England District Church of the Nazarene, Ministerial Studies Board secretary as necessary for my ministerial licensing with this district.

Signed: ______________________________________________________

Print Name _____________________________________________ Date: __________________

Please mail this form, with the Application Fee of $50.00, to: Reynolds Institute, Vanessa Fringer, 60 Kimball Hill Rd, Hudson, NH 03051