Audit Application Form

Title of the course you are interested in auditing:*

Are you a Brethren Academy TRIM, EFSM or SEBAH Student?

I would like to receive CEUs for this course.*

Yes
No

The cost for CEUs is $10. Please contact Janet L. Ober Lambert, director of The Brethren Academy for Ministerial Leadership, at oberlja@bethanyseminary.edu or 765-983-1820 to complete the CEU process.

How did you hear about Bethany Theological Seminary?*

Anticipated Start Date

Term

August Intensive 2023
Fall 2023
January Intensive 2024
Spring 2024
May Intensive 2023
August Intensive 2024
Fall 2024

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Gender

Date of Birth*

Social Security Number

Demographic Information

Race/Ethnic Group

Place of Birth

Current Career

Marital Status

Household Members

Religious Affiliation

Faith Tradition

Congregation

If Church of the Brethren, Your District

Ministerial Status (e.g. Licensed, Ordained)

Year of Ordination/Licensure

Ordaining/Licensing District or Judicatory

Educational Preparation

Highest Level of Education Experience*

Please list colleges, universities, and seminaries attended, and/or other ministry training programs in which you have participated, beginning with the most recent.

Some College Work
Bachelor's Degree
Some Graduate Work
Graduate Degree

Educational Institution #1*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Attended*

Degree Achieved (if applicable)*

Educational Institution #2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Attended

Degree Achieved (if applicable)

Educational Institution #3

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Attended

Degree Achieved (if applicable)

Additional Space (if needed)

References

Please submit the name and contact information of two distinct persons, not related to you, to serve as a reference on your behalf. References are only contacted if additional information is needed for assessing the applicant's ability to study and participate in a course at a graduate level.

Reference #1*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Relationship to You:*

Reference #1*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Relationship to You:*

Background Information

If you answer 'Yes' to any of these questions, please explain in the space provided.

Have you ever been disciplined by a judicatory body responsible for ministerial ethics?*

Yes
No

Explanation

AFFIRMATION

By clicking "Submit," I hereby affirm that all the information contained in this application is factually correct and honestly presented. I understand that any omission or falsification of information on this application may be grounds for denial of admission or immediate dismissal. I also understand that all documents submitted for application become the property of Bethany Theological Seminary and are not returnable or transferable to any third party.

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