APPLICANT INFORMATION

Date:
Social Security Number:	- -
Last Name:
First Name:
Middle Name:
Name Preferred:
Permanent Home Address:
Present Mailing Address:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Present Occupation:
How did you learn about Central?
For what program are you applying?	Select Option Master of Divinity Master of Arts (Theological Studies) Master of Arts in Missional Church Studies Master of Arts in Missional Church Studies (Urban Ministry) Diploma (for persons without a Bachelor degree)
Which location would you like to attend?	Select Option Shawnee, KS (main campus) Milwaukee, WI Murfreesboro, TN Kansas City Urban Ministry Program
When do you expect to begin your study?	(mm/yyyy)
Do you plan to enroll full or part time?	Select Option Full Time (3 more classes per semester) Part Time (full-time is 3 or more classes per semester)
Have you ever been convicted of a felony?	Select Option Yes No
Are you a citizen or permanent resident of the United States?	Select Option Yes No
Marital Status:	Select Option Single Married
If married, what is your spouse's name?
If you have children, what are their names and ages?

EDUCATION INFORMATION
Please list all postsecondary education beginning with the most recent.

CHARACTER REFERENCES
Central requires three character references for as part of the admission process for a degree program. One reference should be from your pastor (current pastors should use a ministry mentor or supervisor). References from family members/relatives will not be accepted.

Reference #1
Name:
Relationship to You:
Reference #2
Name:
Relationship to You:
Reference #3
Name:
Relationship to You:

CHURCH BACKGROUND

Member of (Church Name):

Denominational Affiliation:

Examples: American Baptist, Southern Baptist, Cooperative Baptist, National Baptist, United Methodist, Presbyterian USA, Disciples of Christ, Lutheran

Church Mailing Address:

If on a church staff, in what capacity?

Are you Licensed or Ordained? Select Option Licensed Ordained Neither

*If Licensed or Ordained, attach a photocopy of the License or Ordination Certificate with the signature page you mail to Central Seminary

FINANCIAL INFORMATION

How do you plan to pay for your seminary education?

List your outstanding debts from previous education
(include Guaranteed Student Loans):

Will you apply for the federal loan program? Select Option Yes No
(Complete the federal loan application at www.fafsa.ed.gov. School Code: G01907)

TITLE IX INFORMATION
This information is used only in accordance with TITLE IX of the Education Amendment of 1972. The information is voluntary and refusal to provide it will not subject you to any adverse treatment.

Gender: Not Required Male Female       Birthday: (mm/dd/yyyy)

Race: Not Required American Indian or Alaska Native Asian Black/African American Hispanic/Latino Native Hawaiian or Other Pacific Islander White Multiple Races Race and Ethnicity Unknown Other

NON-DISCRIMINATION POLICY

Central Baptist Theological Seminary does not discriminate on the basis of race, color, national origin, sex, age, or handicap in admission, access to, treatment, or employment in its programs and activities.

VERIFICATION STATEMENT

I certify that the information provided in the online Application for Admission is complete and accurate to the best of my knowledge. I understand that any falsified information in this application and supporting documents could result in my admission to Central Baptist Theological Seminary being rejected.

  (Please type your intials to authenticate the online application)

Prior to submitting the form, you may want to review your answers to ensure their accuracy. Any inaccuracies discovered at a later date could slow the application process.