The Capital ConneXion
"Equipping God's People to Reach the City"
Student Application
for Admission
Director of Admissions
The Capital ConneXion
4915
45th Street, N.W.
Washington, DC 20016
info@thecapitalconnexion.com
This application should be filled
out personally by the applicant and mailed or emailed directly to The Director
of Admissions at the address above.
Mr.
1. Legal Name Mrs. Name you prefer:
Miss Last First Middle
2. Present Address:
(Street & Number) (City) (State) (Zip) (Country)
3. Permanent Address:
(Street & Number) (City) (State) (Zip) (Country)
4. Phone: Home: ( ) Work: ( )
5. Birth Date: 6. Social Security Number:
7. Email address:
_______________ 8. Birthplace: 9. Citizenship
(Nationality):
10. Marital Status:
□ Single
□ Married
□ Divorced
□ Widowed
Spouse's Name: Date of Marriage:
Children (Names &
Ages):
NOTE: If you have ever been
divorced, please explain and attach to application.
11. Do you have any health
condition which would limit your ability to pursue active graduate study?
□ Yes
□ No
Are you now, or have you ever been under psychiatric
care?
□ Yes
□ No
NOTE: If yes, please attach a
statement giving details and give name and address of the psychiatrist who
treated you.
12. Have you ever had
extreme financial difficulties, ever been insolvent or bankrupt?
□ Yes
□ No
NOTE: If yes, please explain and
attach statement to application.
13. Have you ever been
refused admittance or re-admittance by any school? □ Yes
□ No
NOTE: If yes, please explain and attach statement to application.
14. Education Background:
(Applicant is responsible for having official transcripts sent directly to the
Office of Admissions
by each school listed
below.)
Name of Attendance Degree/ Year degree was/will Approximate
Institution From / To Diploma be received G.P.A.
15. Employment or Business Experience (Kind
& Length; add a sheet if necessary):
16. Please read the
Statement of Faith on the web site and respond to the
following questions.
Are you in agreement with this statement?
□ Yes
□ No
Are there areas of disagreement or areas in which you have
not formed an opinion?
□ Yes □ No
If yes to last question, please state which ones.
______________________________________________________
17. When did you come to trust in
Jesus Christ as your Savior and Lord? ___________________________________________________
18. Denominational Preference:
19. Church Membership:
___________________________________________________________________________
20. Ministerial
Status:
□ Under Care
□ Licensed
□ Ordained
Name of body granting this status and when:
_________________________________________________________
21. What do you think are
your spiritual gifts and why? ____________________________________________________
22. What is your present
ministry? (Give position, church or organization, and address.)
___________________________
23. What books or articles
have you published? __________________________________________________________
24. Indicate the term and
year you plan to begin study:
_____________________________________________________
25. Is there an extension center of The Orlando Institute within driving distance of you?
Orlando Jacksonville Miami Cleveland Los Angeles (Chinese) Washington, DC
26. Study Program:
□ Leadership Training Curriculum
□ Great Commission Training
Curriculum
27. On a separate page,
please write a comprehensive account of your Christian experience, your
relationship to the Lord Jesus Christ, your philosophy of ministry, and your
future vocational goals.
28. Please enclose a recent
photograph, a resume, and a one-time, non-refundable application fee of $45.00
with this form.
Applicant's Signature: Date: ______________
The Capital ConneXion maintains a
non-discriminatory admissions policy. Please see the Catalog for details.