KSOM Enrollment Form

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    Student Enrollment Form

    Kentucky School of Ministry

    A ministry of

    The Kentucky District Council of the Assemblies of GodPO Box 98

    7206 Clore LaneCrestwood, Kentucky 40014

    Stan Holder, Director

    Phone: 502-241-7111 Fax: 502-241-7112Email: [email protected] Website: www.kyag.org

    Name: __________________________ Home phone: ____________________Address: ________________________ Cell phone: ____________________City: _________________ Zip: _________ Email: ______________________

    Church you attend: ____________________ City: ____________________Pastor: _________________________

    Please indicate below which level of ministry credential you are studying for.

    _____ Certificate of Ministry ______ Youth Ministry

    _____ Licensed ______ Childrens Ministry

    _____ Ordained _____ I am not studying for credentials

    Please return the completed enrollment form and the $25 enrollment feeto the Kentucky District office via postal mail.

    Upon enrollment students register for classes one at a time.The registration fee for each class session is $60.

    Email Stan Holder ([email protected]) or phone the District Office (502-241-7111)for class schedules, registration forms, and more information.

    (Over)

    http://kyag.org/http://www.kyag.org/http://www.kyag.org/mailto:[email protected]:[email protected]://www.kyag.org/http://kyag.org/

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    IMPORTANT: My initials here _______ verify my agreement that:

    1) I am at least 18 year old, or if I am not at least 18 years old, Iunderstand that I must have an adult accompany me if I choose to stay on

    the grounds for the school

    2) Successful completion of KSOM courses does not guaranteecredentialing with the Assemblies of God

    3) Prior to class instruction, a thorough self-review of the text is required

    4) I will be prepared to turn in my study guide at the start of the class forgrading. In addition, I will be sure to have two hard copies of my studyguide and bring them me. One to turn in, and one for my own use.

    5) My name, photo/video likeness, testimonials, etc. may be used forinformational/promotional purposes related to KSOM or the KentuckyDistrict AG without my further consent or remuneration


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