Post Graduate Diploma

Full Name *

First

Middle

Last

Phone No. *

Email *

Country *

State *

Province/Local Govt/Region *

Street Name *

Date of Birth *

Gender

Marital Status *

Course Applied For *

Please tick as appropriate

Certification *

Please tick as appropriate

Entry Level *

Please tick as appropriate

Mode of Lectures *

Online
Offline
Both

Church Name *

Name of your Pastor *

First

Last

Pastor Tel. No.

Area of Calling *

Please indicate current responsibility at your local assembly

Name of Referee *

First

Last

Reference Tel. No.

Your Expectation from the University

How did you get to know us *

Please tick as appropriate

Signature

Write your full name in capital letters

Attestation *

Please tick

I promise to abide by the rules and regulations guiding my admission into this University. I promise to display a very high sense of responsibility. I agree that my admission can be terminated at any point in time if I am found wanting in speech and character.