Application for Certificate in Ministerial Studies and Certificate in Lay Leadership

Student Information

Name*

First Name Middle Name Last Name

Preferred Name (if different than First Name) Former Last Name (if different than Last Name)

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

*if different from permanent address

Email*

Telephone / Mobile Phone Number

Biographical Information

Sex

Birth Date

MM

DD

YYYY

Country of Citizenship*

Immigration Status*

Student Visa
Permanent Resident

Program Information

Application for session*

Starting in Year*

Applying to:*

Course Load*

Academic History

High School*

Name of School	Location (City/Town, Province/State, Country)	Degree granted	Major & Minor	Length of degree	From: To: (e.g. 09/15-06/19)	Was English your language of instruction?

Colleges/Universities

Name of School	Location (City/Town, Province/State, Country)	Degree granted	Major & Minor	Length of degree	From: To: (e.g. 09/15-06/19)	Was English your language of instruction?

Have you previously applied to or attended Acadia University/Acadia Divinity College?

Year of previous application/Year last attended Acadia University

Acadia ID (if known)

Emergency Contact

Relationship

Emergency Contact Name

First Last

Telephone / Mobile Phone Number

Email Address

Check "Yes" if relationship address is the same as your mailing address

Yes
No

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this person an alumni of Acadia University?

Yes
No

I hereby authorize Acadia Divinity College to release application information, admission status, accommodation, and registration information to the above emergency contact

Further Information

Please list mother tongue

What do you hope to achieve through your study at Acadia Divinity College? What are your ministry goals?

What factor had the most influence on your decision to apply to ADC?

Please specify:

How did you learn about ADC?

Please specify:

Certification

I acknowledge that this information is collected to determine my eligibility for admission and scholarship and may be used for compatible purposes as contact information regarding university programs, services, university advancement and development. If admitted, it will form part of the student record and may be disclosed to faculty or members of the university staff, donors, or partner institutions for officially recognized and legitimate use. I certify that all of the information provided on this application is correct. Acadia University is authorized to verify any information provided as part of the application, and I understand that admission granted on the basis of this application or supporting documents will be revoked if the information given is untrue in any material respect. I authorize my school, college or university to release pertinent information, on a confidential basis, to Acadia University to aid in the evaluation of my admissibility and eligibility for awards and prizes. All documents are routinely verified. Information about falsified documents may be shared with other educational institutions.*

In place of your signature, please type your full legal name:

Date