Application - PacRim!

ENRICHMENT APPLICATION
Enrichment courses at Pacific Rim Christian University are
intensive courses not taken for credit. Acceptance is based on
space available, as regular degree seeking students have first
priority. The application fee of $89 is the fee for the course and
will be reimbursed if we are unable to accommodate you.
Contact pacrim.edu, 808-853-1040, admissions@pacrim.edu,
with further questions.
INTENSIVE COURSE
PROFILE PICTURE
☐SPRING 2015 – March 16-20:
GM 2340 Bible and Pop Culture
Please include a photo that
can be used as your profile
picture on Populi. This photo
may also be used as your
nametag once enrolled in
school.
☐SPRING 2015 – March 16-20:
LD 4309 Servant Leadership
☐SUMMER 2015 – May 18-22:
Hermeneutics- Interpreting the Psalms
☐SUMMER 2015 – June 8-19:
A New Vision for the Church
☐SUMMER 2015 – June 22-26:
Moral Authority and Leadership
BIOGRAPHICAL INFORMATION
LEGAL NAME ________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents)
First/Given
Middle (complete)
Jr., etc.
PREFERRED NAME ____________________________________
FORMER LAST NAME(S) _____________________________
US SOCIAL SECURITY NUMBER _________-_______-_________
BIRTH DATE _____________________ ☐ MALE ☐ FEMALE
Required for US Citizens and Permanent Residents applying for financial aid via FAFSA
mm/dd/yyyy
TELEPHONE (____)____-_______ E-MAIL ADDRESS ________________________________ HOME CITY, STATE_______________
PERMANENT HOME ADDRESS _________________________________________________________________________________
Number & Street
Apartment #
____________________________________________________________________________________________________________
City/Town
County or Parish
State/Province
Country
ZIP/Postal Code
HAWAII MAILING ADDRESS, if different from above _________________________________________________________________
Number & Street
Apartment #
____________________________________________________________________________________________________________
City/Town
County or Parish
State/Province
Country
ZIP/Postal Code
Disciplinary History
1) Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9
grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that
resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal,
dismissal, or expulsion from the institution.
☐ Yes ☐ No
th
2) Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?
☐ Yes
☐ No
(Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged,
sealed, annulled, pardoned, destroyed, erased, impounded or otherwise ordered by a court to be kept confidential.)
If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each
incident, explains the circumstances, and reflects on what you learned from the experience.
PACIFIC RIM CHRISTIAN UNIVERSITY
HOW DID YOU LEARN ABOUT PacRim?
☐Church ☐Friend ☐High School ☐Ministry ☐Website ☐Brochure
☐College Fair ☐Other ______________________________________ ☐NACCAP
☐Conference
HOW WERE YOU REFERRED? If you heard from a family/friend, church, college fair, or internet search please indicate specifically
which one. _________________________________________________________________________________________
FEES AND SUBMISSION
APPLICATION FEE $89, checks payable to NEW HOPE CHRISTIAN COLLEGE - HAWAII or pay online through the online application
at pacrim.edu
☐Online Payment
☐Will Mail Payment
☐Payment Attached
APPLICATION IS ALSO AVAILABLE ONLINE AT PACRIM.EDU
PLEASE RETURN PAPER APPLICATIONS TO:
PACIFIC RIM CHRISTIAN UNIVERSITY
ADMISSIONS OFFICE
P.O. BOX 30147
HONOLULU, HI 96820
-- OR -EMAIL DIRECTLY TO
ADMISSIONS@PACRIM.EDU
APPLICATION FOR ADMISSION
I hereby apply for admission to Pacific Rim Christian University and certify that to the best of my knowledge the information given in this
form is true. I understand that I am submitting confidential forms to persons named for reference on this application, and that these
forms are to be returned by them directly to Pacific Rim Christian University Admissions Officer. I waive my right to see the completed
references; I understand that my file may be made available to any appropriate faculty member or administration officer of Pacific Rim
Christian University.
Signature ______________________________________________________________ Date ______________________________
PACRIM.EDU | 808.853.1040 | ADMISSIONS@PACRIM.EDU