SN: ES2508-C001
EASTGATE SCHOOL OF MINISTRY
KORLEMAN (OFF SAMSAM RD.), MEDIE- ACCRA
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APPLICATION FORMS
GENERAL AND THEOLOGICAL STUDIES
Generating Kingdom Bulldozers
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EASTGATE SCHOOL OF MINISTRY, HQ.
Physical Address:
Eastgate Chapel Int. premises
Korleman (Medie), Off Amasaman-Nsawam Rd.
Accra – Ghana
Postal Address:
P.O. Box WY1998, Kwabenya
Accra – Ghana
E-mail:[email protected]
Website: www.kacciglobal.com
eastgatecolleges.webs.com
Cellular: +233 246125323
0243-721054
CURRENT BRANCH: *LARTEH- AKWAPIM
*AFLAO & TOGO – 0545-850571
VISION STATEMENT
To provide higher quality education pursued in a transformed Christian phanerosis of
loyalty and spirituality.
MISSION STATEMENTAs a church based institution; thrive to develop
entrepreneurs, Church Leaders and Azusa leaders.
STUDENT NUMBER APPLICATION NUMBER
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EASTGATE CHRISTIAN COLLEGE – HQ.
KORLEMAN (MEDIE), ACCRA
Affiliation: Team Impact Christian University -USA
COMPLETE THIS FORM IN BLOCK LETTERS
1.0. PERSONAL INFORMATION
Name of Applicant
Dr. Rev. Pastor Mr. Mrs. Miss Other____________
Surname:____________________ First Name:________________
Other Names:___________________________________________
1.1. Date of Birth of Applicant (dd/mm/yyyy) ______/______/_______
Place of Birth:__________________ Country of Birth:____________
Nationality:____________________ Gender:__________________
Languages Spoken:______________________________________
1.2. Religious Background
Christian Muslim Traditional Other_________
1.3 Marital Status
Single Married Separated Widowed
Home Address:
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Digital Address:
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Telephone:
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. Office Residence Mobile
E-mail Address:------------------------------------------------------------------------------------------------
1.4 Would you like to be Ordained and Licensed after your course of study? Yes No
1.5 What title are you seeking to be ordained into (please select)
Pastor Reverend Minister Prophet Apostle Doctor
. Bishop Very Reverend Primate
1.6 What role do you currently play in your church?-----------------------------------------------
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1.7 What is the name of your Ministry?----------------------------------------------------------------
1.8 Where is your Ministry located? ------------------------------------------------------------------
1.9 If not the General Overseer, what is the name of your Senior Pastor? ----------------
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1.10 Does your husband/wife approve of your ordination? -------------- If yes, what is
his/her full name:------------------------------------------------------------------------------------
1.11 What is your spouse’s contact number:--------------------------------------------------------
1.12 Are you into full time or part time ministry?---------------------------------------------------
1.13 Would you want to become a member of KACCI after your ordination?________
1.14 How many members does your ministry currently have?-------------------------------------
2.0. HOW DID YOU HEAR ABOUNT EASTGATE CHRISTIAN COLLEGE?
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Newspaper Television Radio Friends
Students Church Agents Banner
(Please state name or medium)
Name/ Medium:……………………………………………………………………………...
Telephone Number:………………………………………………………………………..
2.1 PLEASE SELECT PROGRAM FROM OUR COURSE OUTLINE
First Choice:________________________________ Code:____________
Second Choice:_____________________________ Code:____________
Third Choice:_______________________________ Code:_____________
2.2 STATUS OF ENROLLMENT SOUGHT (Please tick if applicable)
Full Time Evenings Weekends
2.3. QUALIFICATIONS
SSSCE A’ Level/ ABCE Matured
Teacher’s Cert. A. Transfer HND
O’ Level French Cert. BECE
Degree/Please specify:______________________________________________
Any other qualification:______________________________________________
2.4. DO YOU NEED RESIDENTIAL ACCOMMODATION?
Yes No Residential facility attracts some charges.
2.5. FAMILY DATA
Father’s Name: Mother’s Name:
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Address: Address:
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Profession: Profession:
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Telephone #:___________________ Telephone #:____________________
2.6 MARITAL STATUS OF PARENTS
Married Separated Divorced
3.0. DECLARATION BY A REPUTABLE PERSONALITY
This declaration should be signed by any of the following individuals who should also endorse the
back of one of the three passport size photographs of the applicant. .
These individuals are:
1. Senior Clergy 6. Head of Educational Institution
2. Medical Officer 7. Engineer
3. Bank Manager 8. Police Officer (Inspector and above)
4. Accountant (Certified) 9. Army Officer (Captain and above)
5. Lawyer 10. Senior Civil Officer
THE APPLICATION WILL NOT BE VALID IF DECLARATION IS NOT SIGNED.
I certify that the photocopy endorsed by me is the true likeness of the applicant,
Mr. / Mrs. . Miss. / Dr. / Rev. / Bishop: (Print) _______________________________
who is personally known to me.
Name: ___________________________ Status: ___________________________
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Address:_____________________________ ______________________________
________________________________________________________________________
Telephone Number: ________________________________________________________
E-mail Address: ______________________________________________________
Signature: _____________________________ Date: ________________________
Stamp / Seal of Officer:
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BY THE ADMISSION BOARD
Admission Accepted:________________________ Denied:______________________
Level Admitted to:___________________________________________________________
Programme:_______________________________________________________________
Fee Paid:_________________________________ Balance to be paid:_____________
Qualification for application:_______________________________________________
Rector:___________________________________________________________________
Date; (Commencement):___________________ Date: (Completion):__________________
Graduation Date:_________________________ Award:____________________________
EASTGATE SCHOOL OF MINISTRY, KORLEMAN (MEDIE), ACCRA
* Please take note that all our certificates are for religious purposes and are therefore exempted from
NAB policies.
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