APPLICATION

CONTACT

PHONE (602) 224-1161

Phoenix University of Theology

STUDENT APPLICATION

PERSONAL INFORMATION

1. Social Security Number (Example:448-42- 6789):

2. Last Name:

First:

Middle:

3. 4. Highest level of education attained

5. Are you licensed or ordained? 6. Number of years in fulltime ministry.

7. Permanent Address:

Number, street, apartment:

City:

State:

Zip/postal code:

Country: (Leave blank if United States)

8.Your Local/Current Address if different from above:

Number, street, apartment:

City:

State:

Zip/postal code:

Country: (Leave blank if United States)

Local Phone Number (Example: (602) 555-1212):

9.Telephone number:

Daytime (Example: (602) 555-1212):

Evening (Example: (602) 555-1212):

Cell (Example: (602) 555-1212):

10. Your e-mail address:

website address

11. Fax Number: (Example: (602) 555-1212):

12 Sex: Male Female

13 Birth date (Example: 02-14-1945): Age

14. Are you a United States Citizen? Yes No

If no, please complete the following section:

Country of citizenship:

Country of birth:

Country of Permanent Residence:

Are you currently in the U.S.? Yes No

Are you a permanent resident of the U.S.? Yes No

Date Visa Issued (Example:03-1999)

15. Native language, if other than English:
What language do you speak at home?

Once you push the submit button your application will be sent to the Registrar and you will be taken to a page where you

may pay your application fee online. The Registrar's Office can not process your application until it receives your one time

processing fee.

If you do wish to pay online you may make arrangements with the registrar. (602) 224-1161

Please send questions, concerns, or comments to the Registrar.