First Name*
Middle Name
Last Name
Suffix*
Date of Birth*
Government ID*
Address Type* —Please choose an option—BillingMailingPermanent
Address Line 1*
Address Line 2
City*
State/Province*
Postal Code*
County*
Country*
Email Address*
Phone Type* —Please choose an option—Emergecny Day PhoneOther Cell PhonePermanent Cell Phone
Phone Number*
Gender* —Please choose an option—MaleFemale
Ethnicity* —Please choose an option—American Indian/AlasAsian/Pacific IslandBlack Non-HispanicHispanicInt. Non-res. AlienInt. Resident AlienInternationalMultiracialOtherWhite Non-Hispanic
Marital Status* —Please choose an option—DivorcedMarriedPartnersSeparatedSingleWidowed
Religion
Veteran Status* —Please choose an option—9Army RecruitCh. 31 RehabCh. 32 Post VietnamCh. 34 Regular VeterCh. 35 Widow/ChildChapter 30Chapter 33 Post 9/11Non VeteranROTCVeteran no Benefits
Retired?* YesNo
Program* —Please choose an option—Doctorate/Doctor of Ministry/Doctor of MinistryGraduate/Master of Divinity/Master of Divinity
Interested in Pursuing a Degree?* YesNo
Academic Interests* Ministry Licensing & OrdinationsLevel 1-6AssociatesBachelorsMastersMogul Media CoachStart A Credit BusinessBoost Your Credit Business
I hereby agree to the Kingdom Academic School of Excellence’s Term and Conditions for tuition and enrollment.
