Student Application Form
Date: ________________________Social Security Number: _______________________________________
(month, day, year)
Name: ___________________________________________________________________________________________
(last) (first) (m.i.)
Address: _________________________________________________________________________________________
(street number and name) (apartment number)
City: _________________________________________________ State: ________ Zip: ________________________
Country: _________________________________________________________________________________________
Phone (home): (________)_____________________ Phone (work): (_______)_____________________________
Phone (cell): (_________)_______________________
Date of Birth: ________________________
(month, day, year)
Email: _____________________________________________________________________
Church background: _____________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Ministry involvement, past and present (use additional paper if needed): ___________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please provide your personal testimony of salvation on a separate sheet of paper. Use 250 to 300 words, double-spaced, and sign your name.
Please provide three personal references, including your pastor's if you are not from The River Church, plus friends or relatives. Please have each provider personally submit their reference directly to STC.
I, ______________________________________________________________________,
Signature: _____________________________________________________Date: _____________________________
(your name)
agree to comply and cooperate with all the requirements listed in the student information and application form.
(Please submit this student application form with course payment and $35.00 ($25 for returning student) nonrefundable registration fee to: SALT International, P.O. Box 1271, Appleton, WI 54912-1271. Make checks payable to: River Church, STC in memo.)