Application Form for Admission in
  International Institute of Church Management Inc., FL/PA, U.S.A.
Select the Degree Program in which you want to Enroll in:
Diploma in Theology___
B.Min. ___ B.Th.___ B.D.___
M.Min. ___ M.Th. ___ M.Div. ___
D.D. ___ D.Min. ____ Th.D. ____ 

Ph.D. (in Biblical Studies, in Christian Leadership, in Church Management etc.)
Specify _________________
MEDIUM: ____ English ____ Tamil _____ Malayalam ____ Telugu ____ Hindi _____ Kannada

1. Name :
2. (a) Address (Present):
No. & Name of the street:
Town / City: State:
Country: Pin code:

(b) Address (Permanent):
No. & Name of the street:
Town / City: State:
Country: Pin code:

3. Telephone - Home & Office:
E-mail Address: Website:

4. Present Occupation:

5. Date of Birth: Month /Date/ Year
6. Sex: Male ______ Female ______
7. General/Theological Educational Qualification:
8. Church Membership (Name of the Church):
No. of years of Membership:

9. Name of Pastor:

10. Positions held in Church:

11. Ministry Training:

12. Areas of Specialization desired, if any:

13. Other Ministerial Experience:

14. Long Range Ministry Goals:

15. Source of information about IICM: IICM Rep Name: _________ Through Special Mailing from us ___ IICM Website ___, Anointing Magazine _____, Internet Search/Surfing ____ Name of the Magazine _______ or Specify, if through other source ___

Date: ____________ Place: _______________ SIGNATURE________________
Submission of Copies of all required Certificates and Photos are mandatory to receive your degree .  [The list of certificates which are required are:

A. Any degree or diploma certificate
B. Transcripts of courses done