7/30/2019 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.
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http://kyag.org/http://www.kyag.org/http://www.kyag.org/mailto:[email protected]:[email protected]://www.kyag.org/http://kyag.org/7/30/2019 KSOM Enrollment Form
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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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