Application For Diploma In Theology

1. School Information
Entry Semester

Entry Semester Fall (Deadline is August 1) Spring (Deadline is January 1)
Campus

Campus Main Campus (Arlington, VA) Hampton Roads Southwest Virginia
Program of Study

Program of Study Diploma in Theology Audit Student
2. Personal Information
Full Legal Name Full Legal Name First Middle Last
Social Security Number
Current Address Current Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email Address
Gender

Gender Female Male
Marital Status

Marital Status Single Married
Spouse's Name Spouse's Name First Last
Emergency Contact Emergency Contact First Last
Emergency Phone Emergency Phone - ### - ### ####
Birthdate Birthdate / MM / DD YYYY
Place of Birth
Ethnic Survey (For Statistical Purposes Only)

Ethnic Survey (For Statistical Purposes Only) Latino/Hispanic American Indian/Alaska Native Asian/Pacfic Islander Black/African American White/Non-Hispanic
Name of Your Church
Address of Local Church Address of Local Church
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
3. Educational Background
High School Name
Location
Year of Graduation
GED or Equivalent:

Please Include Year Recieved
College or Other Studies
School 1
Name
Location
Dates Attended
Add Another School?

Add Another School? Yes No
School 2
Name
Location
Dates Attended
Add Another School?

Add Another School? Yes No
School 3
Name
Location
Dates Attended
4. Professional Background

Please send your current resume to enrollment@leland.edu.
Are you currently serving in Christian ministry?

Are you currently serving in Christian ministry? Yes No
What role and where?
5. Application Essay

Write a statement explaining your desire to pursue theological education and your future ministry and/or vocational goals. Include your previous ministry experience, your gifts/calling for ministry, and current involvement in your local church or Christian ministry.

Why specifically, do you want to attend the John Leland Center?

Responses will serve as your writing sample, and your ability to communicate clearly will be evaluated. (1,000 words or less)
Please paste or type your essay into this box
Maximum of 1000 words allowed. Currently Entered: 0 words.
6. Signature
I hereby declare that to the best of my knowledge all information presented herein is accurate and complete.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Application For Diploma In Theology

1. School Information

2. Personal Information

3. Educational Background

College or Other Studies

4. Professional Background

5. Application Essay

6. Signature