register - Atlanta Dream Center School of Ministry

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Dear Atlanta SOM Applicant,
We are excited that you have taken the time to apply to the Atlanta School of Ministry. If you have any questions, please
refer to the information packet, www.atlsom.com, or call our office at (404) 697-1544. Our school offers two different
sessions January-August (1/10/2015-8/8/2015) and September-June (9/12/2015-6/5/2016). On the last page of the
application, please remember to circle which session you are applying for.
Once you have completed the application, place it in an envelope along with a typed or neatly written testimony
(500-words or less), a photo, and the $100 application fee
(Note: the fee is non-refundable). Everything may be mailed to the ATL SOM offices: (address below)
Atlanta School of Ministry
PO Box 54532
Atlanta, GA 30308
After we have received your application, an individual from the School of Ministry staff will contact you and set up a
phone interview. After this is completed the staff will pray over your application, asking for God’s leading and His will
for your life in this season.
Thank you for considering the Atlanta School of Ministry,
Atlanta School of Ministry Staff
PO Box 54532
Atlanta, GA 30308
www.atlsom.com
(678) 653-3171
Atlanta School of Ministry Application
PERSONAL INFORMATION
Full Name
Present Address
City
State
Phone Number
Zip Code
Email
Birth Date_
Age
Facebook Address: www.facebook.com/_________________________________
Marital Status (circle one) Single
Married
Divorced
if married or divorced, how long?
Note: Please submit a second application for
spouse if both are applying
FAMILY BACKGROUND
Name of Father/Guardian
Address
City
State
Zip Code
State
Zip Code
Phone Number_______________________
Accepted Christ?
Yes
No
Occupation
Name of Mother or Guardian
Address
City
Phone Number_______________________
Accepted Christ?
Occupation
Yes
No
3
MEDICAL BACKGROUND
How would you describe your health?
[ ]Excellent [ ]Good [ ]Fair [ ]Poor
List any allergies
List any physical limitations
List any current medications
Have you ever used Illegal drugs?
Yes
No
Dated last used
Have you ever used tobacco?
Yes
No
Date last used
Have you ever consumed alcohol?
Yes
No
Date last used
EMPLOYMENT HISTORY
Present Employer
Position_
Date Hired
Past Employer
Position_
Quit
Laid Off
Date Hired
Fired
Other
Tuition Payment Plan
How do you plan to pay for your tuition?
Will you have the total tuition by Orientation?
Yes
No
If no, please explain
Do you have your own vehicle?
Do you have health insurance?
Yes
Yes
No
No
List any debts, loans, and payments that you have, including the amount due:
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Will your debts be paid off by the start of the SOM session?
Yes
No
If no, how will you make the payments?
CHURCH BACKGROUND
Name of Home Church
Denomination
Address
City
State
Zip Code
Senior Pastor
Youth Pastor
How long have you attended this church?
List the different ministries you are involved in:
Are you a member of this church?
Yes
No
When did you accept Christ?
Have you been baptized with water?
Have you had an Acts 2:4 experience?
Where?
Yes
No
Yes
No
How many times a week do you attend church?
How do your parents/guardians feel about you attending SOM?
References: (Must include a pastor as a reference) [Name. Relation. Phone Number]
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CHURCH BACKGROUND CONTINUED
What is your definition of church?
GENERAL QUESTIONS
What do you plan to do after SOM?
How did you hear about SOM?
If accepted, are you willing to make a nine-month commitment?
Yes
If accepted, are you willing to make a commitment to pay the total tuition?
What size t-shirt do you wear?
[ ]S [ ]M [ ]Lg [ ]XL [ ]XXL [ ]3XL
No
Yes
No
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TUITION AND FEES FOR BOTH SEMESTERS
Room and Board, Tuition, Books, and Stateside traveling - $6,400 (1st year)
Which session are you applying for?
January
September
ADDITIONAL OPTIONS FOR THOSE INTERESTED:
Would you like to sign up for the Worship Program? Yes No
The Purpose of the Worship Program is to equip musicians and singers with the tools necessary to effectively lead
people into victory and intimacy with the Lord. It is for anyone who wants to go deeper in their walk with the Lord and
those who are called to the worship ministry. In this course you will be able to participate in:
-Prophetic Worship
-Leadership and Team Development
-Music Lessons
-Music Theory
-Recording
-Classes on Intercession & Spiritual Warfare
*There is an additional cost of $660 for the Worship program to cover the extra classes and lessons.
Would you like to pursue Accredited College Options?
Yes
No
Although the Atlanta School of Ministry is not an accredited institution, because of the level of depth in our curriculum
program, multiple schools to give our students degree options have approached us. Based on reviewing our syllabus, core
faculty/staff and interacting with alumni, we currently have options which will allow the transfer of credits for all classes
passed with a grade of “C” or above towards an Associates or Bachelors. In most cases, those who complete 3yrs with us may
only have to complete one year of general education courses weather enrolling student as an online or traditional student. For
more information email us at options@Atlsom.com.
*In order for students to be enrolled in college options they need to posses their own laptop. Would you like to sign up for Georgia School of Ministry?
Yes
No
GSOM provides the opportunity for a student to complete requirements for Ordination and Licensing credentials with the
Assemblies of God. Students who sign up attend a weekend course once a month on an outside campus. There are different
levels of licensing available for interested students, for more information email us at options@Atlsom.com. *For more information visit http://gadistag.org/471425.ihtml I HAVE HONESTLY COMPLETED THIS APPLICATION FORM AND HAVE ANSWERED THE QUESTIONS TO THE BEST OF MY
ABILITY AND if accepted, I agree to take full responsibility of paying the total tuition. I understand that I am responsible
for the vehicle, if I choose to bring one, including maintenance, insurance, etc. I agree to provide a current DMV record,
proof of insurance, and a copy of my driver’s license. I agree to cover all expenses and damages if I am borrowing a
vehicle and have an accident or receive a citation.
Print Name:
Date:
Signature: ______________________________________________________
DON’T FORGET TO INCLUDE
1. Personal Testimony
2. Photo
3. $100 Application fee