APPLICATION Application for Enrollment / EvaluationGeneral InformationFull Name:*Street Address:*City:*State:*Zip code:*Country:*Home Phone:Business Phone:Email:* Date of Birth: Date Format: MM slash DD slash YYYY Place of Birth (city, state):Total Years in Ministry:Present Occupation:How long?Social Security Number:*Sex:Please Choose OneMaleFemaleMarital Status:Please Choose OneSingleMarriedDivorcedName of Spouse:Ethnic Origin Information:Please Choose OneCaucasian (Non-Hispanic)Black (Non-Hispanic)American IndianAsian Pacific IslanderHispanicAlaskan NativeKoreanOther-Specify:Payment Plan: 1, 2, or 3Educational InformationName of High School:High School Graduation Date: Date Format: MM slash DD slash YYYY City:State:Previous EducationIn order to evaluation your previous college credits, please provide Bethany with the following information. List all colleges attended in chronological order, (beginnning with the first and ending with the last). You may receive advanced standing for transfer credits earned from other acceptable colleges and seminaries and/or Life Learning Experience and apply them toward your degree program. Bethany only allows 30 credits for life learning and that can only be applied in the undergraduate level. However, and advanced standing, whether it is transfer credits or credit received from Portfolio Learning Assessment, shall in no instance preclude a minimum of 30 credit hours of study with Bethany.Schools Previously AttendedName of Institution:City:State:Hours completed:Dates attended:Institution Degree:Institution Graduation Date: Date Format: MM slash DD slash YYYY School 2Name of Institution:City:State:Hours completed:Dates attended:Institution Degree:Institution Graduation Date: Date Format: MM slash DD slash YYYY School 3Name of Institution:City:State:Hours completed:Dates attended:Institution Degree:Institution Graduation Date: Date Format: MM slash DD slash YYYY Degree InformationWhat degree program do you desire to enroll?Bachelor:Select OneGeneral Bible Diploma - 1 yearAssociate Degree - 2nd yearGraduate of Theology - 3rd yearBachelor of Theological StudiesBachelor of Applied Science in BibleBachelor of Arts in Religion/Christian EducationBachelor of Arts in Religion/Christian CounselingBachelor of Arts in Religion/MissionsBachelor of Arts in Religion/BibleBachelor of Arts in Religion/Pastoral MinistryMaster:Select OneMasters of Arts in Religion/BibleMasters of Arts in Religion/Christian EducationMaster of Ministry/Pastoral MinistryMaster of Ministry/MissiologyMasters of Arts in Religion/Christian CounselingMaster of Theological Studies/Bible/TheologyDoctorate:Select OnDoctor of Biblical StudiesDoctor of Philosophy in Religion/Christian CounselingDoctor of MissiologyDoctor of Ministry/Pastoral MinistryDoctor of Philosophy in Religion/Christian EducationDoctor of Philosophy in Religion/BibleDoctor of Theological Studies/Bible/TheologyLife Learning ExperienceDo you have any life-learning experience that you would like to be considered? In the box below give a brief summary of your life-learning experience that you think might apply towards credits.Payment InformationA one time $50.00 Application/Evaluation fee is required to submit an application for enrollment or evaluation. If the student completes the enrollment, the $50.00 fee will be deducted from the overall cost of the selected degree program.Credit Card InformationType of Credit Card:Select OneVisaMasterCardDiscoverExpiration date: Date Format: MM slash DD slash YYYY Card number:Name on card:Authorization Code:(3-4 digit number found on the back of your card.) This iframe contains the logic required to handle Ajax powered Gravity Forms.