5100 South Cleveland Avenue

Application to Establish an AISOM Study Center:  (Print out and mail):

Today's Date: __________________

Director and Organization Information (Please type or print clearly):

Information about the organization sponsoring or supporting the AISOM Study Center:

______________________________________________________

Name of Director:

______________________________________________________

Name of Organization Hosting AISOM Study Center:

Mailing Address where AISOM Documents will be sent:

______________________________________________________

Address 1:

______________________________________________________

Address 2:

______________________________________________________

City, State, Zip or Postal Code:

______________________________________________________

Country:

______________________________________________________

Phone Number:

______________________________________________________

Email Address:

______________________________________________________

Web Site:

______________________________________________________

Type of Organization (i.e., church, ministry, education center, etc.):

Reason for starting an AISOM Study Center at your location:

_____________________________________________________________________________________

_____________________________________________________________________________________

How did you learn about AISOM? __________________________________________________________

_____________________________________________________________________________________

Director Information:                          

Information about the person who will oversee the AISOM Study Center:

Name: ______________________________________________________

                                       (First)                            (Middle)                            (Last)

Country of Citizenship: ____________________

Primary Employer: _______________________ Occupation: ___________________________

Employer’s Address: ____________________________________

Telephone: (______)_______________

Level of educational experience:
High school:
Some college:

College degree: (Degree & Major: _______________)
Graduate degree: (Degree and Concentration Area: _______________)

First Language: _______________________

Additional Language(s): _______________________

Church Affiliation Information: (Note: For information only.)

Church Name: _________________________________________

Denomination: _________________________________________

Church Address: _______________________________________

City: _________________ State: ____ Zip: ______

Country: _______________________________

Senior Pastor’s Name: _________________________________

Church Telephone: (______)___________

Reference Information:

Please provide reference to a person who can discuss the organization and its commitment to biblical education:

Name: ________________________________________ Position: ________________________

Address: _________________________________ City: ____________ State: _____ Zip: ______

Country: ______________________________________ Telephone: (______)_____________

Email: ______________________________________

Statement of Application and Code of Conduct:

I certify that the information provided on this application for admission is complete and correct.

I certify that our AISOM Study Center will abide by the rules, regulations and expectations of the Ames International School of Ministry, as amended, and will adhere to the highest standards of Christian character and behavior in all staff and students.

Signature of Applicant:  ______________________________________       Date:  __________________

Print out and mail to:

Ames Christian University

5100 South Cleveland Avenue