ENROLLMENT APPLICATION FORM

Please PRINT or TYPE.  Please answer all questions.  Incomplete applications will be returned and may delay your acceptance to PCU. 
If the question does not pertain to you please enter N/A.  Date and sign your completed application and submit with listed (non-refundable)
 fee payment to:  PCU, Admissions, P. O. Box 5304, Kaneohe, HI  96744.

 

Personal Information

Last Name

First Name

M.I.

SR, JR or

Maiden Name, if applicable

Mailing Address

City

State

Zip Code

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Work

Email

Birth date    MM/DD/YYYY

Social Security Number

Sex M= Male  F=Female

Nationality

Marital Status S= Single M=Married

U S Citizen?             If No, what country?

Church Information  

Church Name		Church Address, City, State, Zip
Church Phone	Church Pastor			# of years attending	Church denomination or background
Current Ministry Status, if any Senior Pastor, Assistant / Youth / Children’s Pastor, Lay Minister, etc.	Please indicate if you are currently licensed and/or ordained & Credentialing Organization		Yrs in Ministry	List Past Ministry involvement, such as Pastoral, Evangelism, Teaching, Radio/TV, etc.

Educational Information  

Please support all educational background with the following:  Copy of High School Diploma or G.E.D.  From Bible Colleges and/or institutes and/or schools, or other
 colleges or universities, please submit an original, sealed, official transcript sent directly to PCU.  Applicants are responsible to request, pay for and/or follow up as
 necessary the request of all transcripts 

High School Name  / Location	Date Started	Date Ended	Interest or Major Studied	Yrs Completed	Diploma / Degree Earned?

Non-Discrimination Policy

Pacific Christian University affirms that all men are created in the image of God and are, therefore, to be afforded equal
opportunity in accordance with biblical standards. These policies are administered to without regard to gender, color, national or ethnic origin, recognizing that all mankind is one human race.

Please see Student Handbook for Privacy Rights

Please Share Your Salvation Testimony  - continue on back if needed

Briefly Share your educational / ministry goals.  - continue on back if needed

 

***PLEASE READ CAREFULLY BEFORE SUBMITTING***

By submitting this form, I acknowledge that I have answered all questions to the best of my knowledge.  I authorize
Pacific Christian University (PCU) to verify all information I have disclosed as applicable.  I understand that my completion
of the program does not guarantee any employment or position with any church or organization.  I understand that all
payments are non-refundable. 

 

Student Signature:	Date: