CHRISTIAN ACADEMY FOR LEADERSHIP STUDIES Accredited Member of Nations Association for Theological Accreditation (NATA) and South India Christian Council, Bangalore H.O.: 8/69C, Harris House, Alanchi Road, Rithapuram - 629 159 Cell: 9442935233, 7502071054 Study Centre: Study Centre Code No: Application for B.Th B.Min M.Div. M.Min M.B.S M.R.E M.Th PGADBC Please tick your choice C.Th/D.Th BBS B.T.S B.D M.C.S M.T.S M.A M.B.A M.S.W Lessons in Tamil / English Applied for: Regular/Part-time/Correspondence/ Open University System Name Date of Birth Age Church Denomination Years of Experience in Ministry Your Present Position in Church PastorEvangelistDeaconTeacherBeliever Are you married? NoYes If yes, spouse name No of Children Are you a Divorcee? NoYes If yes, reason Permanent Address Present Address Nationality Mother Tongue Phone (with code) Cell Enter the Degree Email Educational Qualification Secular Educational Qualification Theology Name & Address of Last Institution, you studied Name of your church Pastor Your Church Location/ Place D D Number Bank DD/MO Date DECLARATION I, hereby, declare that all the information given above are true to the best of my knowledge. I am solely responsible for my Christian life and conduct Date Upload Your Signature of the Candidate Please Attach i) Xerox copies of all certificates and Mark sheets. (if possible, SSLC onwards) ii) Age proof certificate for the open university candidates. (Birth or Church Certificates) iii) Brief Testimony of Conversion and Two Photo FOR OFFICIAL USE ONLY Register Number Remarks if any ADMISSION GRANTED/REJECTED Office Seal Date