SHORT TERM COURSE

Plot No 81, 4th Cross st, Senthil Nagar, Kollathur Chennai 600 099+91 44 26501290 / 26501390 email: info@ezekiahfrancis.org  www.ezekiahfrancis.org

APPLICATION FORM

Affix your passport size photograph

 
 Name                                                      Telephone          Off :  

Address :                                                   (with STD code)    Res: 

                                                                                     

 Dist:                     Pin:                                  E mail :        

                                     

Educational            

Qualification  :

Languages known :            

 Age - Date of Birth &                  

Occupation    :        

Family Details

Marital Status                   :  Married                         Sex:      Male/ Female

                                         Single

                                         Widow(er)

 

Spiritual Experience

Do you have the Born- again experience            :  ______     

If yes,  have you taken water baptism                :____  If yes, date________

Have you received the Baptism of the Holy Spirit :____ If yes, date________

Church Affiliations

Name of your church                   :

Address                                     :

Your present involvement

in ministry                                  :

         

Why do you want to attend

the S.T.C                                   :

         

Has anyone from your family

attended /or applied?                    :        

 

Are you getting our news letter/

magazine.  If not would you like

to subscribe   ( Annual subscription

Rs.150/-)

Do you have any physical or

mental disability?                         :

         

Date   :

Place  :                                                                  Signature of the candidate

 

Write your testimony in a separate paper

Check list

        Check the following before sending the application:

                Rs.500 / - should be sent along with your application towards Registration fees

Passport size photograph

                                Whether testimony is attested                                                                                          

                                Address with pincode and telephone nos, email id          

        Instructions

1. Incompleted  forms will be rejected.

2. Please send your application forms before  without fail.

3. Only those who receive our call letter are eligible to attend the course.

4. The details of the course fees will be intimated in the call letter.

5. The course - management has the right to send back home any candidate if necessary.

 


FOR OFFICE USE ONLY

Remarks :                                                               Reg. No.      :                                              

Selected : Yes / No                                                 Batch No.     :