Application Rec'd Date Accepted Student Email:

12808 Woodruff Ave, Downey CA 90242

APPLICATION FOR ADMISSION

(For AUDIT Student)
(Please type or print clearly)
(First Name)

NAME
(Last Name) (Middle Name)

ADDRESS

CITY

STATE

ZIP CODE

HOME PHONE (

WORK PHONE (

AGE

BIRTH DATE

SOC. SEC. NUMBER CHILDREN AGES

MARITAL STATUS (S M D W) Circle one

How did you hear about our school? For what semester are you applying:

Fall ________ Spring ________ Summer ________

Address

20_______

Occupation/Trade Employer Emergency contact: Name Phone ( ) Relationship Address

City State Zip

MEDICAL INFORMATION (USE A SEPARATE SHEET OF PAPER IF NECESSARY) Are you in good health? Do you have any physical handicaps? List any major illness you have had: Do you have any communicable disease? (Explain) Have you been or are you presently under psychiatric or physiological care, or been in counseling or psychotherapy? (Explain) Have you ever been hospitalized or admitted to a treatment facility for any reason? If so, where? (Explain) When was your last complete physical examination?

GENERAL INFORMATION (USE A SEPARATE SHEET OF PAPER IF NECESSARY) Are you a current smoker? (If yes, explain) Do you currently drink alcoholic beverages? (If yes, explain) Do you have any personal history of violence or abuse towards others, or of sexual immorality? (If yes, explain) Does your life currently conform to Biblical standards of morality? (If not, explain) Is there any habitual sin in your life that affects your walk with God? (If yes, explain) Are you currently involved in any problematic interpersonal relationships? (If yes, explain) Have you ever been involved in any non-Christian cult or occult activities? (If yes, explain)

SPIRITUAL LIFE PROFILE (PLEASE USE A SEPARATE SHEET OF PAPER.)

1. Please describe in detail your testimony on how you became a Christian or your born-again experience. 2. Please describe your current church involvement. 3. Where do you attend church? 4. How often do you go to church? 5. How long have you been a part of this fellowship?
STATEMENT OF FAITH (ON A SEPARATE SHEET OF PAPER)

Pastor's name?

Address of church?

Please write a brief, but concise statement (minimum of one paragraph) of your belief regarding the following:
1. THE BIBLE 6. SALVATION 9. THE RAPTURE 2. GOD 3. JESUS CHRIST 4. THE HOLY SPIRIT 5. SIN

7. BAPTISM OF THE HOLY SPIRIT 10. ETERNAL SECURITY

8. ESCHATOLOGY (end times events)

STUDENT'S SIGNATURE Please submit this application with a small photograph of yourself.

DATE:

12808 Woodruff Ave. Downey, CA 90242 (562) 803-5621

REGISTRATION FORM
Semester: Name (Last): Address: Home Phone #: (
Will be attending: Are you seeking:

Spring

Summer

Fall

Year 20 ____ (First) City:

Student Email:

____________ (Middle) St: Zip:

PRINT ONLY

)
Full-time Degree

Work Phone #: (
Part-time for credit Certificate of Completion

)
Audit only Personal Interest

Please list all courses you are registering for. Enter information in each box.
Room # Course # Course Title Day Time Units Credit/ Audit

Application Fee $25.00 Registration Fee $25.00 (for Credit Student) F/T Student 12+ Units ($100.00 Reg. Fee non-refundable) $600.00 P/T Student: Total # units _____ x $50.00 AUDIT Student tuition: Total # of classes ____ x $50.00 TOTAL TUITION DUE

= $ ________ = $ ________ = $ = $ = $ = $

PLEASE NOTE: MAIL-IN REGISTRATION MUST BE ACCOMPANIED BY REGISTRATION FEE AND 25% MINIMUM TUITION DOWNPAYMENT - MAKE CHECKS PAYABLE TO: CALVARY CHAPEL OF DOWNEY

OFFICE USE ONLY

Amount Paid $ Date: Check /MO # Initials:

Original Student File Yellow Semester File Pink Student Copy