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Program Information
Contact Information
Personal Information
Parent/Guardian Information
Academic
Disclosures
Required
is required
is Required
First Name
Required
Middle Name
Required
Last Name
Required
If you have academic records under another name, please indicate
Required
Email Address
Required
Social Security Number
Required
Date of Birth
Required
Gender
Required
-- choose one --
Female
Male
Unknown
Are you Hispanic?
Required
-- choose one --
NO
YES
Ethnicity
Required
-- choose one --
AMER. IND/ALASK
ASIAN/PAC ISLAND
BLACK, NON HISP
CAPE VERDEAN
EGYPTIAN
HAITIAN
HISPANIC
OTHER
WHITE, NON HISP
What is your Racial Background?
Required
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Marital Status
Required
-- choose one --
Clergy
Divorced/Seperated
Married
Single
Unknown
Widowed
is Required
Permanent Home Address
Street 1
Required
Street 2
Required
City
Required
State
Required
-- choose one --
ALABAMA
ALASKA
AMERICAN EMBASSY
AMERICAN SAMOA
ARIZONA
ARKANSAS
ARMED FORCES THE PACIFIC
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINA
WISCONSIN
WYOMING
Zip Code
Required
Zip Code Extension
Phone Number
Required
Phone Number Area Code
Phone Number Exchange
Phone Number Number
Phone Number Extension
Ext:
Temporary Mailing Address
Copy Home Address Into Mail Address
Required
Mail Street 1
Required
Mail Street 2
Required
Mail City
Required
Mail State
Required
-- choose one --
ALABAMA
ALASKA
AMERICAN EMBASSY
AMERICAN SAMOA
ARIZONA
ARKANSAS
ARMED FORCES THE PACIFIC
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINA
WISCONSIN
WYOMING
Mail Zip Code
Required
Mail Zip Code Extension
is Required
If you are under under 24 and would like to provide parent/guardian information, we invite you to do so.
Parent/Guardian Relationship
Required
-- choose one --
Aunt
Business
Child
Educational Partner
Emergency Contact
Employee
Employer
Ex-Spouse
Externship site
Guardian
Host Family
Husband
Internship
Internship Supervisor
Parent/Guardian
PLACEMENT
Shadow
Student
Third Party
Trustee
Uncle
Widow
Wife
First Name
Required
Last Name
Required
Email Address
Required
Phone Number
Required
Phone Number Area Code
Phone Number Exchange
Phone Number Number
Phone Number Extension
Ext:
is Required
High School / GED attended
Required
College / University attended
Required
College / University attended
Required
College / University attended
Required
What program are you applying for?
Required
-- choose one --
AS in Psychology
BA in Biblical Studies
BS in Psychology
Bereavement and Grief Counseling Certification Program
Chaplaincy Certification
Certificate in Lay Counseling
Dual Enrollment
When do you want to start your program?
Required
-- choose one --
Spring 2025
Summer 2025
Fall 2025
Do you intend to enroll Part-Time or Full-Time?
Required
-- choose one --
3/4 time
Full Time
Half Time
less than half time
Are you a United States Veteran?
Required
-- choose one --
Not a veteran
Veteran = Yes
Please, let us know if you will apply for financial assistance or Veterans benefits.
Required
-- choose one --
Applying for Aid
is Required
If you are an Alabama state resident, please indicate your residing county
Required
Please check all the boxes that apply to you:
Required
I have been dismissed, expelled, and/or suspended from college for a disciplinary reason
I have been convicted for a violation of either a federal, state, county or municipal law
E-Signature (Please type your full name & today's date):
Required
Anticipated Graduation Date (MM/DD/YYYY)
Required
I do hereby swear or affirm that all information included on this application is complete and accurate. I understand that not disclosing information requested or giving false answers could result in ineligibility for admission. I agree to follow all university policies and procedures. I will be honest in all my academic endeavors. I have read the Statement of Faith and understand that this is the foundation upon which the University is built and operates.
Please be aware that your application is not considered final until you have remitted the required application fee. Upon submission of your application, you will be directed to the payment page in order to provide the appropriate amount.