STUDENT APPLICATION FORM

STUDENT APPLICATION FORM

TRAINING FOR LEADERSHIP; EDUCATING FOR SERVICE; ENVISIONING FOR MINISTRY!

Please complete all the information below and return to L.W.A.

You may copy the application form and e-mail it to us AT lIVINGWAYACADEMY@AOL.COM

your signature will be required upon arrival at the academy.

Tick as appropriate: Miss. □ Mrs. □ Mr. □ Ms. □ Other: ___________

Full Name: _____________________________________________

Address: _______________________________________________

_________________________________ Post Code _____________

Telephone No. _____________ E-mail: _______________________

Date of Birth: ________________ Marital Status: ______________

Occupation ________________ Church attending: _____________

How often do you attend? __________________________________

How many years have you been attending this church? ___________

Course applying for: _____________________________________

* Pastor/Leaders Name, address and Telephone No. * _______________________________________________________________

I agree with the terms and conditions outlined ON THE WEBSITE AND in the prospectus.

Signature __________________________________

Please attach a separate page explaining reasons why you are applying for this course.