SHORT TERM COURSE

Plot No 81, 4^th 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. :