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:
E-MAIL ADDRESS:
__________________________________________
Birth Date _______________________ Ethnic/Cultural Group (Optional)
__________________
Church Name ___________________________________ Denomination
__________________
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_______________________
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,