APPLICATION SERVICE FORM

Full Name of Applicant (Founder/Chancellor/Rector/Director) * *

Gender *

Male
Female

Marital Status *

Single
Married
Separated
Divorce

WhatsApp No. *

Email *

Which country do you reside in? *

State/Region/Province * *

Local Govt./County/District * *

Highest Education Qualification *

Please select your highest certificate

Name of your Ministry/Institute/Organization *

Address of your Ministry/Institute/Organization *

Years of Establishment *

Level of Certification *

Please choose level of membership you are applying for.

How does your students receive lecture *

Online
Offline
Both

State the services your organization/ministryinstitute offers *

Your Expectation from our organization *

How did you get to know us *

Online
Offline

Signature *

Write your full name in capital letters

Attestation *

Tick

I promise to abide by the rules and regulations guiding my Service with Chosen Life Christian University. I promise to display a very high sense of responsibility. I agree that my Certificate of Service can be terminated at any point in time if my organization goes contract to the deeds of contract binding this relationship.