Please enable JavaScript in your browser to complete this form.U.S.C.I.A Badge NumberName *FirstMiddleLast Address *FirstMiddleLastCountry *FirstLastSocial Security #Telephone *Email *Gender *MaleFemale Place of Birth *FirstMiddleLastCitizenship *United StatesOtherDate of Birth *FirstLastMarital Status *SingleMarriedRe- MarriedSeparatedDivorcedWidowedSpouse Name Do you Plan to Attend *Choice 10Full TimePart TimeUndergraduate Programs RU & USCIA Chaplaincy CertificateChaplaincy CertificateCertificate of MinistryAssociate of TheologyAssociate of Christian CounselingAssociate of MinistryBachelor of MinistryBachelor of TheologyBachelor of Christian CounselingBachelor of Elem. EducationBachelor Degree ProgramsBachelor of MinistryBachelor of Christian CounselingGraduate Programs Choose OneMasters of MinistryMasters of TheologyMasters of Christian CounselingDoctor of MinistryDoctor of TheologyDoctor of Christian CounselingPrevious Education InformationFirstMiddleLastPrevious College 1FirstMiddleLastPrevious College 2FirstMiddleLastAre You Ordained Choice 8NoYesIf Ordained Select Title Choose OneSenior PastorAssistant PastorDeaconElderBishopApostleName on Debit/Credit Card *For the dual Certificate of Chaplaincy with Rhema University and U.S.C.IA. The total amount will be $475.00.Type Of Card * VisaMasterDiscoverCard Number *3 Digit CSC ( On Back of Card ) *Expiration Month *Choice 16010203040506070809101112Expiration Year *Choice 12202220232024202520262027Place Your Name Here As Your Signature *FirstLastI have read this online presentation of Rhema University and agree to abide by the standards as set forth. I have told the truth to the best of my ability on this application. I further acknowledge that no other representations have been made to me in writing or orally other than what is stated in this online presentation. I understand that all information given in this application is subject tox verification and will be confidential.MessageSubmit Application