APPLICATION FOR ADMISSION

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.

Thank you! We look forward to working with you!

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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