Today's Date:                    Student ID#:

Full Name:                 
                              Last                       First            Middle Initial

Address:

City:       State:       Zip:

Home Phone:       Cell Phone:

Email:

Date of Birth:        Married Single Widow
                       If Married, Enter Spouse's Name:

Are you a Minister? Yes No      Date of Conversion:

Are you a Layperson? Yes No                   Male Female

What Spiritual Gifts are currently operating in your life?
Prophesy Tongues Evangelist Apostle Pastor Teacher
Laying on Hands Deliverance Interpretation Other:

How did you hear about KTC? Referral Other:

What formal education do you have?
High School College Other: Degrees:

Are you an active member of a Church? Yes No
    If yes, Church Name:

Pastor's Name:

Phone:

How long have you been ministering?

Have you received License or Ordination? Yes No
    If yes, what your:



Evaluate yourself in your level of study: 1=Poor / 2=Average / 3=Excellent

My ability to learn verbally 1 2 3

Rate your learning abilites 1 2 3

My ability to learn by reading information by myself 1 2 3

Rate your learning abilities 1 2 3