Arkansas Institute of Holy Land Studies
9700 Highway 107 Sherwood, Arkansas 72120
(1-800-617-6205)
or
501-835-1453
or, FAX: 1-501-835-1453
rmoseley@cei.net
Arkansas Institute of Holy Land Studies
9700 Hwy. 107
Sherwood, AR 72120
FAX: 1-501-835-6504
TELE: 1-501-835-1453
1-800-617-6205
General Information: (*Please
print or type legibly)
Please include a recent photograph for your AIHLS file.
Date:_______________________________
Legal Name:_________________________________________________
Preferred Name:______________________________________________
Mailing Address:______________________________________________
City:______________________________State:___________Zip:_______
Home Phone: _____________________ Work Phone:________________
Date of Birth:______________________Sex: [ ] Female [ ] Male
Marital Status: [ ] Married [ ] Separated [ ] Divorced [ ] Single
Church Affiliation: (Local)________________________________________
Church Address:_______________________________________________
Pastor:______________________________ Phone:__________________
Are you Employed? [ ] No [ ] Yes
Work Phone:______________________
Citizenship: [ ] USA [ ] Other, Name of Country______________________
If other, are you a permanent resident of the United States? [ ] Yes [ ] No
List other relatives who are presently attending AIHLS:_________________
Name:______________________________Relationship:________________
Name:______________________________Relationship:________________
Educational Information:
List chronologically high school (or GED), all colleges, universities and/or technical schools previously attended:
High School (Name and Address):_________________________________________
__________________________________Graduation Date:___________________
College(s) Attended Name and Address:___________________________________
___________________________________________________________________
___________________________________________________________________
Number of Credits earned______________
Admission Status:
Have you already taken the AIHLS Entrance Evaluation Examination? [ ] Yes [ ] No
Have you previously attended or taken any courses through AIHLS? [ ] Yes [ ] No
What classification are you interested in pursuing? [Check all that apply!]
[ ] Full Time Student [ ] Resident Student [ ] Auditing Student
[ ] Part Time Student for Credit [ ] Bachelor Certification
[ ] Master's Certification [ ] Correspondence Student [ ] Satellite Student
THE $25 APPLICATION FEE MUST ACCOMPANY THIS FORM!
Please list your choice(s) of courses here:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
In order to have
the correspondence materials sent out to you as soon as possible,
please enclose a check or money order to cover the cost of the
courses you've selected and the application fee.
We accept Visa, Mastercard, Discover, and American Express credit
cards.
If you prefer to make payment by use of one of these cards,
please fill out the information below:
Please circle one: VISA DISCOVER MASTERCARD AMERICAN EXPRESS
Name as shown on card: _________________________________________
Card Number:___________________________________________________
Expiration Date:____________________
Signature:_________________________
Please include three references from: (1) Someone who knows about your work performance; (2) Someone who knows about your academic performance; (3) Someone who knows you personally.
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