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ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext=3D"edit" spidmax=3D"3074"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext=3D"edit"> <o:idmap v:ext=3D"edit" data=3D"1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=3DEN-US style=3D'tab-interval:.5in'> <div class=3DSection1> <table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi= dth=3D665 style=3D'width:498.6pt;margin-left:-.05in;border-collapse:collapse;border:= none; mso-border-alt:solid windowtext .5pt;mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext;mso-border-insidev:.5pt solid win= dowtext'> <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:5.25pt'> <td width=3D660 colspan=3D2 valign=3Dtop style=3D'width:495.0pt;border:so= lid windowtext 1.5pt; background:#CCCCCC;padding:0in 5.4pt 0in 5.4pt;height:5.25pt'> <h6>GENERAL INFORMATION</h6> </td> </tr> <tr style=3D'mso-yfti-irow:1;height:625.5pt'> <td width=3D660 colspan=3D2 valign=3Dtop style=3D'width:495.0pt;border:so= lid windowtext 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:625.5pt'> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Name _________________________________________________________________________= ________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:7.0pt;color:black'><span style=3D'mso-spacerun:yes'>       &nbs= p;   </span>Last<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span>First<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;             </span>Middle<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:7.0pt;color:black'><o:p>&nbs= p;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Preferre= d Name ____________________________________ Social Security Number _____________= ___<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Other na= mes under which your transcript(s) may be listed _______________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Mailing Address ________________________________________________________________________<= o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><st1:place w:st=3D"on"><st1:PlaceType w:st=3D"on"><span style=3D'font-size:11.0pt;ms= o-bidi-font-size: 10.0pt;color:black'>City</span></st1:PlaceType><span style=3D'font-size= :11.0pt; mso-bidi-font-size:10.0pt;color:black'> <st1:PlaceName w:st=3D"on">_____= ________________________</st1:PlaceName> <st1:PlaceType w:st=3D"on">State</st1:PlaceType></span></st1:place><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'> _______= __ Zip ____________ Phone _________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Sex:<span style=3D'mso-spacerun:yes'>  </span>__Male __Female<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>Date of Birth _____/_____/_____<span style=3D'mso-spacerun:yes'>       &nbs= p;     </span>E-mail_______________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Country = of Citizenship ___________________<span style=3D'mso-spacerun:yes'>        </s= pan>Is English your primary language?<span style=3D'mso-spacerun:yes'> &nbs= p; </span>__Yes<span style=3D'mso-spacerun:yes'>  </span>__No<o:p></o:p= ></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Marital status: __Single<span style=3D'mso-spacerun:yes'>   </span>__Engaged<span style=3D'mso-spacerun:yes'>    </span>__Married<span style=3D'mso-spacerun:yes'>    </span>__Separated<span style=3D'mso-spacerun:yes'>    </span>__Divorced<span style=3D'mso-spacerun:yes'>    </span>__Widowed<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Name of = spouse (if applicable): ________________________________________________________= ____<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Number of Children: _________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>Ages: _____<span style=3D'mso-spacerun:yes'>  </span>_____<sp= an style=3D'mso-spacerun:yes'>  </span>_____<span style=3D'mso-spacerun:yes'>  </span>_____<span style=3D'mso-spacerun:yes'>  </span>_____<span style=3D'mso-spacerun:yes'>  </span>_____<span style=3D'mso-spacerun:yes'>  </span>_____<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>Name, ad= dress, and phone of nearest relative:<span style=3D'mso-spacerun:yes'>  </span>________________________________________________<o:p></o:p></span>= </p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>________= ___________________________________________________________________________= ___<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'>List nam= es and state relationship of any relative(s) who have attended or are attending AESOM or FICU.<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;       </span><u>Name</u><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;         </span><u>Relationship</u><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;       </span>AEM or FICU<o:p></o:p></span></p> <ol style=3D'margin-top:0in' start=3D1 type=3D1> <li class=3DMsoNormal style=3D'color:black;mso-list:l1 level1 lfo1;tab-s= tops: list .5in;mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt'>_______________= _____________<span style=3D'mso-spacerun:yes'>      </span>_____________________________<span style=3D'mso-spacerun:yes'>      </span>________________<o:p></o:p></span></li> <li class=3DMsoNormal style=3D'color:black;mso-list:l1 level1 lfo1;tab-s= tops: list .5in;mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt'>_______________= _____________<span style=3D'mso-spacerun:yes'>      </span>_____________________________<span style=3D'mso-spacerun:yes'>      </span>________________<o:p></o:p></span></li> <li class=3DMsoNormal style=3D'color:black;mso-list:l1 level1 lfo1;tab-s= tops: list .5in;mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt'>_______________= _____________<span style=3D'mso-spacerun:yes'>      </span>_____________________________<span style=3D'mso-spacerun:yes'>      </span>________________<o:p></o:p></span></li> <li class=3DMsoNormal style=3D'color:black;mso-list:l1 level1 lfo1;tab-s= tops: list .5in;mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt'>_______________= _____________<span style=3D'mso-spacerun:yes'>      </span>_____________________________<span style=3D'mso-spacerun:yes'>      </span>________________<o:p></o:p></span></li> </ol> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:7.0pt;color:black'><o:p>&nbs= p;</o:p></span></p> <p class=3DMsoBodyText align=3Dleft style=3D'text-align:left'>The followi= ng questions are used for statistical purposes only. You are not required to complete this section of the application. If you complete this section, t= he information will not be used in evaluating your application for enrollmen= t. FICU does not discriminate against applicants on the grounds of race, col= or, sex, age, national origin, disability, or veteran status.</p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><b><span style=3D'font-size:10.0pt;color:black'>Church Attendance<o:p></o:p></span= ></b></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;color:black'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'tab-stops:9.0pt;mso-layout-grid-align:none; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>Please = check one from the following list:<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>__</span></b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>Assembly of God<span style=3D'mso-spacerun:yes'>  </span>__Church of God in Christ<span style=3D'mso-spacerun:yes'>  </span>__Independent<span style=3D'mso-spacerun:yes'>       &nbs= p;        </span>__Nazarene<span style=3D'mso-spacerun:yes'>       &nbs= p;           </span>__Presbyterian<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>__</span></b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>Baptist<span style=3D'mso-spacerun:yes'>       &nbs= p;           </span>__Episcopalian<span style=3D'mso-spacerun:yes'>       &nbs= p;            </span>__Interdenominational<span style=3D'mso-spacerun:yes'>   </span>__Non-denominational<span style=3D'mso-spacerun:yes'>  </span>__Protestant<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>__</span></b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>Catholic<span style=3D'mso-spacerun:yes'>       &nbs= p;   </span><span style=3D'mso-spacerun:yes'>      </span>__F= reewill Baptist<span style=3D'mso-spacerun:yes'>       &nbs= p;      </span>__Jewish<span style=3D'mso-spacerun:yes'>    &= nbsp;           &nbs= p;        </span>__Open Bible Standard<span style=3D'mso-spacerun:yes'>  </span>__Southern Baptist<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>__Charismatic<span style=3D'mso-spacerun:yes'>       &nbs= p;   </span>__Full Gospel<span style=3D'mso-spacerun:yes'>       &nbs= p;             </span>__Lutheran<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp; </span>__Pentecostal<span style=3D'mso-spacerun:yes'>       &nbs= p;         </span>__Other_________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'>__Church of Christ<s= pan style=3D'mso-spacerun:yes'>   </span>__Holiness<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;     </span>__Methodist<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p> </o:p></s= pan></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> <div style=3D'mso-element:para-border-div;border-top:solid windowtext 1.5= pt; border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none; padding:1.0pt 0in 1.0pt 0in'> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one; border:none;mso-border-top-alt:solid windowtext 1.5pt;mso-border-bottom-a= lt: solid windowtext 1.5pt;padding:0in;mso-padding-alt:1.0pt 0in 1.0pt 0in'><= span style=3D'font-size:10.0pt;color:black'>Church Name<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;          </span>Pastor’s Name<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one; border:none;mso-border-top-alt:solid windowtext 1.5pt;mso-border-bottom-a= lt: solid windowtext 1.5pt;padding:0in;mso-padding-alt:1.0pt 0in 1.0pt 0in'><= span style=3D'font-size:10.0pt;color:black'><o:p> </o:p></span></p> </div> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;color:black'>Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   </span>City<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;    </span>State<span style=3D'mso-spacerun:yes'>       &nbs= p;       </span>Zip<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:black'><o:p>&nb= sp;</o:p></span></p> </td> </tr> <tr style=3D'mso-yfti-irow:2;height:14.25pt'> <td width=3D660 colspan=3D2 valign=3Dtop style=3D'width:495.0pt;border:so= lid windowtext 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;background:#CCC= CCC; padding:0in 5.4pt 0in 5.4pt;height:14.25pt'> <h3><span style=3D'font-size:12.0pt;font-family:TimesNewRoman'>EMPLOYMENT= /SERVICE<o:p></o:p></span></h3> </td> </tr> <tr style=3D'mso-yfti-irow:3;height:613.5pt'> <td width=3D660 colspan=3D2 valign=3Dtop style=3D'width:495.0pt;border:so= lid windowtext 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:613.5pt'> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'>Please com= plete this section, even when a current resume is also sent.<o:p></o:p></span><= /p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'><o:p> = ;</o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"'>CURRENT EMPLOYER:<o:p></o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'>__________= ____________________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;     </span>__________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Name of Employer<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span>Position Held<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'>___________________________________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;             </span>_________________________________________________________<o:p></o:= p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Employer Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   </span>Month/Year<span style=3D'mso-spacerun:yes'>        </span>to<span style=3D'mso-spacerun:yes'>     &= nbsp; </span>Month/Year<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Brief Job Description/Duties:<span style=3D'mso-spacerun:yes'>  </span>__________________________________________________________________= __<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>______________________________________________= ______________________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"'>PREVIOUS EMPLOYERS (Do not list jobs held more than 10 years ago.):<o:p></o:p></sp= an></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"'><o:p> </o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'>1.<span style=3D'mso-spacerun:yes'>  </span>______________________________<s= pan style=3D'mso-spacerun:yes'>       &nbs= p;             </span>__________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Name of Employer<span style=3D'mso-spacerun:yes'>  </span><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;</span>Position Held<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'>___________________________________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;             </span>__________________________________________________________<o:p></o= :p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Employer Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   </span>Month/Year<span style=3D'mso-spacerun:yes'>        </span>to<span style=3D'mso-spacerun:yes'>     &= nbsp; </span>Month/Year<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Brief Job Description/Duties:<span style=3D'mso-spacerun:yes'>  </span>__________________________________________________________________= _<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>______________________________________________= _____________________________________________</span><span style=3D'font-family:TimesNewRoman'><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'>2.<span style=3D'mso-spacerun:yes'>  </span></span><span style=3D'font-size:= 7.0pt; font-family:TimesNewRoman'><span style=3D'mso-spacerun:yes'> </span>= </span><span style=3D'font-family:TimesNewRoman'>______________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;             </span>_________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Name of Employer<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span>Position Held<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;tab-stops:6.05in;mso-layo= ut-grid-align: none;text-autospace:none'><span style=3D'font-size:7.0pt;font-family:Time= sNewRoman'>___________________________________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;             </span>________________________________________________________<o:p></o:p= ></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Employer Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   </span>Month/Year<span style=3D'mso-spacerun:yes'>        </span>to<span style=3D'mso-spacerun:yes'>   </span><span style=3D'mso-spacerun:yes'>    </span>Month/Year<o:p>= </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Brief Job Description/Duties:<span style=3D'mso-spacerun:yes'>  </span>__________________________________________________________________= _<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>______________________________________________= _____________________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;tab-stops:444.6pt;mso-lay= out-grid-align: none;text-autospace:none'><span style=3D'font-family:TimesNewRoman'>3.<sp= an style=3D'mso-spacerun:yes'>  </span>______________________________<s= pan style=3D'mso-spacerun:yes'>       &nbs= p;      </span><span style=3D'mso-spacerun:yes'>       </sp= an>_________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Name of Employer<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span>Position Held<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'>___________________________________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;             </span>________________________________________________________<o:p></o:p= ></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Employer Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   </span>Month/Year<span style=3D'mso-spacerun:yes'>        </span>to<span style=3D'mso-spacerun:yes'>     &= nbsp; </span>Month/Year<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;font-family:TimesNewR= oman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Brief Job Description/Duties:<span style=3D'mso-spacerun:yes'>  </span>__________________________________________________________________= _<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>______________________________________________= _____________________________________________</span><span style=3D'font-size:7.0pt;font-family:TimesNewRoman'><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"'>MILITARY INFORMATION<o:p></o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"'><o:p> </o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman'>If you are a veteran, please complete the following:<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;tab-stops:3.8in 282.6pt 4= .05in; mso-layout-grid-align:none;text-autospace:none'><span style=3D'font-size:= 10.0pt; mso-bidi-font-size:12.0pt;font-family:TimesNewRoman'>____________________= _____________<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;       </span><span style=3D'mso-spacerun:yes'>     </span>_________= ___________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'>Branch of Service<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;            </span>Month/Year<span style=3D'mso-spacerun:yes'>       &nbs= p;    </span>to<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>Month/Year<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman'>Discharge:<span style=3D'mso-spacerun:yes'>    </span>__Honorable<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;          </span><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;     </span>__ Other ____________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman'>Are you eligible for VA educational benefits?<span style=3D'mso-spacerun:yes'>    </span>__Yes<span style=3D'mso-spacerun:yes'>     </span>__No<o:p></o:p= ></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; font-family:TimesNewRoman'><o:p> </o:p></span></p> <h1>DETAILED EMPLOYMENT HISTORY</h1> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:"TimesNe= wRoman\,Bold"'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:"TimesNe= wRoman\,Bold"'>__Resume Attached<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;        </span>__Not Applicable<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-family:TimesNewRoman'><o:p> = ;</o:p></span></p> </td> </tr> <tr style=3D'mso-yfti-irow:4;height:16.15pt;mso-row-margin-right:.05in'> <td width=3D660 valign=3Dtop style=3D'width:495.0pt;border:solid windowte= xt 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;background:#CCC= CCC; padding:0in 5.4pt 0in 5.4pt;height:16.15pt'> <h3><span style=3D'font-size:12.0pt'>EDUCATION</span><span style=3D'font-= size: 12.0pt;mso-bidi-font-size:10.0pt;font-family:"TimesNewRoman\,Bold"; color:black'><o:p></o:p></span></h3> </td> <td style=3D'mso-cell-special:placeholder;border:none;padding:0in 0in 0in= 0in' width=3D5><p class=3D'MsoNormal'> </td> </tr> <tr style=3D'mso-yfti-irow:5;height:244.3pt;mso-row-margin-right:.05in'> <td width=3D660 valign=3Dtop style=3D'width:495.0pt;border:solid windowte= xt 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:244.3pt'> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"; color:black'>COLLEGES ATTENDED: <o:p></o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:1= 2.0pt; font-family:TimesNewRoman;color:black'>__________________________________= ___________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>___________________________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Institution Name<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span><st1:place w:st=3D"on"><st1:PlaceName w:st=3D"on">Institution</st1= :PlaceName> <st1:PlaceType w:st=3D"on">City</st1:PlaceType></st1:place>, State <o:p>= </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span>_________________________________= ____________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>____________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>__________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Hours Attended/Degree Completed<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;           </span>Date of Completion<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p; </span>GPA<span style=3D'mso-spacerun:yes'>    </span><o:p= ></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Trans= cript Attached<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;          </span>__Transcript to Follow Later<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;         </span>__No Transcript Available<span style=3D'mso-spacerun:yes'>       &nbs= p;     </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'>  </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:1= 2.0pt; font-family:TimesNewRoman;color:black'>__________________________________= ___________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>___________________________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Institution Name<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span><st1:place w:st=3D"on"><st1:PlaceName w:st=3D"on">Institution</st1= :PlaceName> <st1:PlaceType w:st=3D"on">City</st1:PlaceType></st1:place>, State <o:p>= </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span>_________________________________= ___________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>____________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>__________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Hours Attended/Degree Completed<span style=3D'mso-spacerun:yes'>       &nbs= p;        </span><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;       </span>Date of Completion<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p; </span>GPA<span style=3D'mso-spacerun:yes'>    </span><o:p= ></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Trans= cript Attached<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;          </span>__Transcript to Follow Later<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;         </span>__No Transcript Available<span style=3D'mso-spacerun:yes'> &n= bsp; </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><o:p>&n= bsp;</o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:1= 2.0pt; font-family:TimesNewRoman;color:black'>__________________________________= ___________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>___________________________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Institution Name<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;  </span><st1:place w:st=3D"on"><st1:PlaceName w:st=3D"on">Institution</st1= :PlaceName> <st1:PlaceType w:st=3D"on">City</st1:PlaceType></st1:place>, State <o:p>= </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span>_________________________________= ____________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>____________________________<span style=3D'mso-spacerun:yes'>       &nbs= p;  </span>__________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Hours Attended/Degree Completed<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;           </span>Date of Completion<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p; </span>GPA<span style=3D'mso-spacerun:yes'>    </span><o:p= ></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Trans= cript Attached<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;          </span>__Transcript to Follow Later <span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;        </span>__No Transcript Available </span><b><span style=3D'font-size:10.0pt;font-famil= y: "TimesNewRoman\,Bold";color:black'><o:p></o:p></span></b></p> </td> <td style=3D'mso-cell-special:placeholder;border:none;padding:0in 0in 0in= 0in' width=3D5><p class=3D'MsoNormal'> </td> </tr> <tr style=3D'mso-yfti-irow:6;height:13.5pt;mso-row-margin-right:.05in'> <td width=3D660 valign=3Dtop style=3D'width:495.0pt;border:solid windowte= xt 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;background:silv= er; padding:0in 5.4pt 0in 5.4pt;height:13.5pt'> <h2><span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt'>PERSONAL INFORMATION</span><span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0= pt; font-family:"TimesNewRoman\,Bold"'><o:p></o:p></span></h2> </td> <td style=3D'mso-cell-special:placeholder;border:none;padding:0in 0in 0in= 0in' width=3D5><p class=3D'MsoNormal'> </td> </tr> <tr style=3D'mso-yfti-irow:7;mso-yfti-lastrow:yes;height:359.05pt;mso-row-= margin-right: .05in'> <td width=3D660 valign=3Dtop style=3D'width:495.0pt;border:solid windowte= xt 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:359.05pt'> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'><span style=3D'mso-spacerun:yes'>   </span><o:p></= o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>Why do = you want to attend Agape Embassy’s <st1:place w:st=3D"on"><st1:PlaceType w:st=3D"on">School</st1:PlaceType> of <st1:PlaceName w:st=3D"on">Ministr= y</st1:PlaceName></st1:place>? _______________________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>_______= ___________________________________________________________________________= ___________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>What ar= e your academic and profession goals? Please list short-term and long-term goals. _____________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>_______= ___________________________________________________________________________= ___________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;tab-stops:6.55in;mso-layo= ut-grid-align: none;text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><o= :p> </o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;color:black'>DEGR= EE/CERTIFICATE INTENTIONS: <o:p></o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></b></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>For whi= ch degree level(s) are you applying?<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;  </span>In which degree program are you enrolling? <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Certi= ficate<span style=3D'mso-spacerun:yes'>       &nbs= p;      </span>__Associate<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      </span>__Biblical Counseling<span style=3D'mso-spacerun:yes'>       &nbs= p; </span>__Biblical Studies<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Bache= lor<span style=3D'mso-spacerun:yes'>       &nbs= p;        </span>__Bachelor of Arts<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;        </span>__Church Administration<span style=3D'mso-spacerun:yes'>    </span>__Religious Educatio= n<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Maste= r<span style=3D'mso-spacerun:yes'>       &nbs= p;           </span>__Master of Arts<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            </span>__Religious Fine Arts<span style=3D'mso-spacerun:yes'>       &nbs= p; </span>__Theology<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Docto= rate<span style=3D'mso-spacerun:yes'>       &nbs= p;      </span>__Doctorate of Philosophy<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><o:p>&n= bsp;</o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><b><span style=3D'font-size:10.0pt;color:black'>CURR= ENT MINISTRY STATUS </span></b><span style=3D'font-size:10.0pt;color:black'>(= check all that apply) <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>Are you= a minister? __Yes<span style=3D'mso-spacerun:yes'>  </span>__No<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;     </span>If yes:<span style=3D'mso-spacerun:yes'>  </span>__Ordained –Year_______<span style=3D'mso-spacerun:yes'>       </span>__Licensed – Year_______ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>Credent= ials issued by _____________________________Denominational background _______________________</span><span style=3D'color:black'> <o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>If you = are currently involved in ministry, what is your role? <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Senior Pastor<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;   </span>__Drama/Performances<span style=3D'mso-spacerun:yes'>  </span>__Children’s Ministry<span style=3D'mso-spacerun:yes'>  </span>__Youth Ministry<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>__Assoc= iate/Assistant Pastor<span style=3D'mso-spacerun:yes'>   </span>__Missions Tri= p<span style=3D'mso-spacerun:yes'>       &nbs= p;      </span>__Prayer Group<span style=3D'mso-spacerun:yes'>       &nbs= p;    </span>__Church Leadership/Council<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;    </span>__Music Programs<span style=3D'mso-spacerun:yes'>       &nbs= p; </span>__Other_____________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>If you = are currently Senior Pastor, please supply the following information: <o:p></= o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;color:black'>_______= ___________________________________________________________________________= ___________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Church Name <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;color:black'><span style=3D'mso-spacerun:yes'> </span>_________________________________= ___________________________________________________________________________= ________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;     </span>City<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;      </span>State<span style=3D'mso-spacerun:yes'>       &nbs= p;         </span>Zip<span style=3D'mso-spacerun:yes'>   </span><o:p></o:p= ></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:7.0pt;color:black'>________= ___________________________________________________________________________= __________________________________________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'margin-left:9.0pt;mso-layout-grid-align:non= e; text-autospace:none'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7= .0pt; color:black'>Phone<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;           </span>Fax<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;      </span>Web Address<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;   </span>E-mail </span><b><span style=3D'font-size:10.0pt;font-family:"Time= sNewRoman\,Bold"; color:black'><o:p></o:p></span></b></p> </td> <td style=3D'mso-cell-special:placeholder;border:none;padding:0in 0in 0in= 0in' width=3D5><p class=3D'MsoNormal'> </td> </tr> </table> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:non= e'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><o:p> = ;</o:p></span></p> <table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi= dth=3D708 style=3D'width:531.0pt;margin-left:-.05in;border-collapse:collapse;border:= none; mso-border-alt:solid windowtext .5pt;mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext;mso-border-insidev:.5pt solid win= dowtext'> <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:12.0pt'> <td width=3D708 valign=3Dtop style=3D'width:531.0pt;border:solid windowte= xt 1.5pt; background:#CCCCCC;padding:0in 5.4pt 0in 5.4pt;height:12.0pt'> <h4><span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt'>STATEMENT = OF TRUTH<o:p></o:p></span></h4> </td> </tr> <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;height:185.25pt'> <td width=3D708 valign=3Dtop style=3D'width:531.0pt;border:solid windowte= xt 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:185.25pt'> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'>I understand that all items submitted to Agape Embassy’= ;s <st1:PlaceType w:st=3D"on">School</st1:PlaceType> of <st1:PlaceName w:st=3D"on">Ministry= </st1:PlaceName>, an affiliate of <st1:place w:st=3D"on"><st1:PlaceName w:st=3D"on">Friends= </st1:PlaceName> <st1:PlaceName w:st=3D"on">International</st1:PlaceName> <st1:PlaceName = w:st=3D"on">Christian</st1:PlaceName> <st1:PlaceName w:st=3D"on">University</st1:PlaceName></st1:place>, as pa= rt of the application process become the permanent property of AESOM/FICU and w= ill not be returned to me. <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoBodyText2>I hereby state that the information contained in = this application is correct and true. If AESOM/FICU is notified that any information contained herein is false, it will be grounds for my immediate denial or dismissal. I also understand that completion of this applicatio= n in no way guarantees or implies acceptance and/or enrollment as a student at AESOM/FICU. </p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'>To qualify for admission to AESOM/FICU, you must be a member= of the Body of Christ.<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'><o:p> </o:p></span></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'>__I am a member of the body of Christ<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;     </span><span style=3D'mso-spacerun:yes'>    </span>__= I am not a member of the body of Christ<span style=3D'mso-spacerun:yes'>  </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-size:10.0pt;font-family:TimesNew= Roman; color:black'>I declare that all information given to be true to the best = of my knowledge. <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'text-align:justify;mso-layout-grid-align:no= ne; text-autospace:none'><span style=3D'font-family:TimesNewRoman;color:black= '><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-family:TimesNewRoman;color:black'>_________________________= _________________<span style=3D'mso-spacerun:yes'>       &nbs= p;          </span>____________________ <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;mso-bidi-font-size:7.0pt;font-family:TimesNewRo= man; color:black'>Signature<span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;  </span><span style=3D'mso-spacerun:yes'>       &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  </span>Date</span><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:TimesNewR= oman; color:black'> <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:7.0pt;font-family:TimesNewRoman;color:black'><span style=3D'mso-spacerun:yes'> </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><span style=3D'mso-spacerun:yes'>     </span><o:p></o:p></s= pan></p> </td> </tr> </table> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:non= e'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><o:p> = ;</o:p></span></p> <table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 style=3D'margin-left:5.4pt;border-collapse:collapse;border:none;mso-border= -alt: solid windowtext .5pt;mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-border-insid= eh: .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'> <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:9.0pt'> <td width=3D648 valign=3Dtop style=3D'width:6.75in;border:solid windowtex= t 1.5pt; background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:9.0pt'> <h4><span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt'>For Offici= al Use Only<o:p></o:p></span></h4> </td> </tr> <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;height:151.5pt'> <td width=3D648 valign=3Dtop style=3D'width:6.75in;border:solid windowtex= t 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:151.5pt'> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>Acceptan= ce Date<span style=3D'mso-spacerun:yes'>  </span>___<span style=3D'mso-spacerun:yes'>   </span>/ ___ / ____ <o:p></o:p></= span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><span style=3D'mso-spacerun:yes'>     </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>Applicat= ion & Registration Fee paid by <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>__Cash<s= pan style=3D'mso-spacerun:yes'>  </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>__Check = <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>__Money = Order <o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><st1:PlaceName w:st=3D"on"><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;col= or:black'>Affiliate</span></st1:PlaceName><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'> <st1:Pl= aceType w:st=3D"on">Center</st1:PlaceType>:<span style=3D'mso-spacerun:yes'>  </span><b>AESOM</b> (Agape Embassy’s <st1:place w:st=3D"on"><st1:Pl= aceType w:st=3D"on">School</st1:PlaceType> of <st1:PlaceName w:st=3D"on">Ministr= y</st1:PlaceName></st1:place>)<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><o:p>&nb= sp;</o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>Advisor: ______________________________________________<o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><span style=3D'mso-spacerun:yes'>       &nbs= p;  </span><o:p></o:p></span></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'>Faculty Acceptance: _____________________________________<span style=3D'mso-spacerun:yes'>     </span><o:p></o:p></s= pan></p> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><span style=3D'font-size:10.0pt;font-family:TimesNewRoman;color:black'><o:p>&nb= sp;</o:p></span></p> </td> </tr> </table> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:non= e'><b><span style=3D'font-family:Arial;color:white'><o:p> </o:p></span></b></p> <table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 style=3D'margin-left:5.4pt;border-collapse:collapse;border:none;mso-border= -alt: solid windowtext .5pt;mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-border-insid= eh: .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'> <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:15.0pt'> <td width=3D648 valign=3Dtop style=3D'width:6.75in;border:solid windowtex= t 1.5pt; background:#CCCCCC;padding:0in 5.4pt 0in 5.4pt;height:15.0pt'> <h5>ADMINISTRATIVE NOTES<span style=3D'font-family:Arial;color:white'><o:= p></o:p></span></h5> </td> </tr> <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;height:160.05pt'> <td width=3D648 valign=3Dtop style=3D'width:6.75in;border:solid windowtex= t 1.5pt; border-top:none;mso-border-top-alt:solid windowtext 1.5pt;padding:0in 5.4= pt 0in 5.4pt; height:160.05pt'> <p class=3DMsoNormal style=3D'mso-layout-grid-align:none;text-autospace:n= one'><b><span style=3D'font-family:Arial;color:white'><o:p> </o:p></span></b></p> </td> </tr> </table> <p class=3DMsoNormal><o:p> </o:p></p> </div> </body> </html> ------=_NextPart_01C8F8AB.6BD38720 Content-Location: file:///C:/5E8596C9/AEMSOMApplicationforAdmissions(AEMSOMFICU)_files/header.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" <html xmlns:v=3D"urn:schemas-microsoft-com:vml" xmlns:o=3D"urn:schemas-microsoft-com:office:office" xmlns:w=3D"urn:schemas-microsoft-com:office:word" xmlns:st1=3D"urn:schemas-microsoft-com:office:smarttags" xmlns=3D"http://www.w3.org/TR/REC-html40"> <head> <meta http-equiv=3DContent-Type content=3D"text/html; charset=3Dus-ascii"> <meta name=3DProgId content=3DWord.Document> <meta name=3DGenerator content=3D"Microsoft Word 11"> <meta name=3DOriginator content=3D"Microsoft Word 11"> <link id=3DMain-File rel=3DMain-File href=3D"../AEMSOMApplicationforAdmissions(AEMSOMFICU).htm"> <![if IE]> <base href=3D"file:///C:\5E8596C9\AEMSOMApplicationforAdmissions(AEMSOMFICU)_file= s\header.htm" id=3D"webarch_temp_base_tag"> <![endif]><o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"Street= "/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"City"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"State"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PostalCode"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"address"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceType"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceName"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place"/> <!--[if gte mso 9]><xml> <o:shapedefaults v:ext=3D"edit" spidmax=3D"3074"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext=3D"edit"> <o:idmap v:ext=3D"edit" data=3D"2"/> </o:shapelayout></xml><![endif]--> </head> <body lang=3DEN-US> <div style=3D'mso-element:footnote-separator' id=3Dfs> <p class=3DMsoNormal><span style=3D'mso-special-character:footnote-separato= r'><![if !supportFootnotes]> <hr align=3Dleft size=3D1 width=3D"33%"> <![endif]></span></p> </div> <div style=3D'mso-element:footnote-continuation-separator' id=3Dfcs> <p class=3DMsoNormal><span style=3D'mso-special-character:footnote-continua= tion-separator'><![if !supportFootnotes]> <hr align=3Dleft size=3D1> <![endif]></span></p> </div> <div style=3D'mso-element:endnote-separator' id=3Des> <p class=3DMsoNormal><span style=3D'mso-special-character:footnote-separato= r'><![if !supportFootnotes]> <hr align=3Dleft size=3D1 width=3D"33%"> <![endif]></span></p> </div> <div style=3D'mso-element:endnote-continuation-separator' id=3Decs> <p class=3DMsoNormal><span style=3D'mso-special-character:footnote-continua= tion-separator'><![if !supportFootnotes]> <hr align=3Dleft size=3D1> <![endif]></span></p> </div> <div style=3D'mso-element:header' id=3Dh1> <p class=3DMsoHeader align=3Dcenter style=3D'text-align:center'><b><span style=3D'font-family:Arial;mso-no-proof:yes'><!--[if gte vml 1]><v:shapetype id=3D"_x0000_t75" coordsize=3D"21600,21600" o:spt=3D"75" o:preferrelative= =3D"t" path=3D"m@4@5l@4@11@9@11@9@5xe" filled=3D"f" stroked=3D"f"> <v:stroke joinstyle=3D"miter"/> <v:formulas> <v:f eqn=3D"if lineDrawn pixelLineWidth 0"/> <v:f eqn=3D"sum @0 1 0"/> <v:f eqn=3D"sum 0 0 @1"/> <v:f eqn=3D"prod @2 1 2"/> <v:f eqn=3D"prod @3 21600 pixelWidth"/> <v:f eqn=3D"prod @3 21600 pixelHeight"/> <v:f eqn=3D"sum @0 0 1"/> <v:f eqn=3D"prod @6 1 2"/> <v:f eqn=3D"prod @7 21600 pixelWidth"/> <v:f eqn=3D"sum @8 21600 0"/> <v:f eqn=3D"prod @7 21600 pixelHeight"/> <v:f eqn=3D"sum @10 21600 0"/> </v:formulas> <v:path o:extrusionok=3D"f" gradientshapeok=3D"t" o:connecttype=3D"rect"/> <o:lock v:ext=3D"edit" aspectratio=3D"t"/> </v:shapetype><v:shape id=3D"_x0000_s2049" type=3D"#_x0000_t75" style=3D'po= sition:absolute; left:0;text-align:left;margin-left:54pt;margin-top:1.8pt;width:71.3pt; height:33.3pt;z-index:-1'> <v:imagedata src=3D"image001.png" o:title=3D""/> </v:shape><![endif]--></span></b><b><span style=3D'font-family:Arial'>APPLI= CATION FOR ADMISSIONS<o:p></o:p></span></b></p> <p class=3DMsoHeader align=3Dcenter style=3D'text-align:center'><b><span style=3D'font-family:Arial'>AGAPE EMBASSY’S <st1:place w:st=3D"on"><s= t1:PlaceType w:st=3D"on">SCHOOL</st1:PlaceType> OF <st1:PlaceName w:st=3D"on">MINISTRY<= /st1:PlaceName></st1:place><o:p></o:p></span></b></p> <p class=3DMsoHeader align=3Dcenter style=3D'text-align:center'><b><span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>(AES= OM/FICU)<o:p></o:p></span></b></p> </div> <div style=3D'mso-element:footer' id=3Df1> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt'><o:p> </o:p></span= ></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Dr. J= oseph A. Mills, Jr., Dean<o:p></o:p></span></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><st1:addres= s w:st=3D"on"><st1:Street w:st=3D"on"><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt;font-= family: Arial'>5775 Barclay Dr., Ste. 7</span></st1:Street><span style=3D'font-si= ze: 8.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>, <st1:City w:st=3D"on"= >Alexandria</st1:City>, <st1:State w:st=3D"on">VA</st1:State><span style=3D'mso-spacerun:yes'>&nbs= p; </span><st1:PostalCode w:st=3D"on">22315</st1:PostalCode></span></st1:addr= ess><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><o:p>= </o:p></span></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Phone= :<span style=3D'mso-spacerun:yes'>  </span>703.971.7202<span style=3D'mso-spacerun:yes'>     </span>Fax:<span style=3D'mso-spacerun:yes'>  </span>703.971.7638<o:p></o:p></span></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:8.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>www.a= gapembassy.org<o:p></o:p></span></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><o:p>=  </o:p></span></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt'><o:p> </o:p></span= ></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt'><o:p> </o:p></span= ></p> <p class=3DMsoFooter align=3Dcenter style=3D'text-align:center'><span style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt'><o:p> </o:p></span= ></p> </div> </body> </html> ------=_NextPart_01C8F8AB.6BD38720 Content-Location: file:///C:/5E8596C9/AEMSOMApplicationforAdmissions(AEMSOMFICU)_files/image001.png Content-Transfer-Encoding: base64 Content-Type: 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