APPLICATION FORM FOR ADMISSION

INTERNATIONAL INSTITUTE OF CHURCH MANAGEMENT
G-1, Ruby Tower, 240, Velachery Road, Selaiyur. Chennai 600 073, INDIA
Tel: 91-44-2239 2325 / 2239 5149 / 2239 5346

Tick the relevant fields

Depending upon your Denomination back-ground and interest you can choose one of the following combinations of Study:
Traditional Theological Track:____                 Pentecostal Charismatic Track:_____            A Blend of both:_____

Preferred Language :   English ___   /  Tamil ___  / Telugu (Only Bachelor Degrees) ___

__ B.Min    __ B.Th     __ B.Div    __ B.B.S 

__  M.Min   __ M.Th   __ M.Div    __ M.B.S   __  M.C.L  __ M.C.M   __ M.Mis 

__ D.Min   __ D.Mis __ D.Div     __Th.D    __ S.T.D    __  Ph.D (Biblical Studies)

1. Name :________________________________________________________ 

2. Home Address :_________________________________________________ 

                              _________________________________________________   

                              City / Dist ___________________State_________________

                                                                          Pin Code 

3. Telephone : Res ____________________ Off _________________________          

            E-mail ID :____________________________________________ 

4. Present Occupation/Business/Career :_______________________________ 

5. Date of Birth :_____________________                               Male / Female 

6. Educational Qualification : a. Academic :______________________________
 

                                                b. Technical :______________________________

7. a. Theological Qualification :________________________________________

    b. Ministry Training              :________________________________________

8. Ministerial Experience :____________________________________________

9.      Denomination and Name of the Church in which you have membership :____________________________________

 10. Name of your Pastor :____________________________________________

 11. Position held in Church :__________________________________________

 12. Long Range Ministry Goals :_______________________________________

 13. Area of Specialization* :___________________________________________
      (*For Doctoral / Masters Degree Students only)

 14. How did you come to know about IICM Degree Programs ?   ________________
       For eg. ANOINTING / Magazine Advertisements (indicate the name of the magazine) / IICM Website / Any other source. If you came to know about IICM
       through a Student or Representative or Extension Centre Director please give details

 I hereby declare that all the information submitted above are true to the best of my knowledge.

______________                    _______________                  ___________________

       Date                                           Place                                      SIGNATURE

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 Read the following before you mail this form…

a. Please check whether all the columns have been filled in.
b. Attach or send two recent passport size Color Photos.
c. Attach copies of High School/College/University, Bible School Certificates / Degrees.
d. Send a Money Order or a Bank Draft in favor of “IICM EDUCATIONAL TRUST”    towards the REGISTRATION FEES 

e.      Fee Payment Plan:

Plan I – Full Payment
Plan II – Initial Payment of 25% from the total course fee and pay the balance amount
               of 75% should be paid within 6 months   –  5% more in the total fees.
Plan III – Initial Payment of 25% from the total course fee and pay the balance amount
                of 75% should be paid within 12 months – 10% more in the total fees.

 f.   Fees paid are not refundable.

g.   If you would like to receive a copy of our Catalog, please send Rs.50/- by M.O. or D.D to IICM OFFICE: IICM EDUCATIONAL TRUST, G-1, RUBY TOWER, 240, VELACHERY ROAD, SELAIYUR. CHENNAI 600 073. INDIA

Present Fee Structure for IICM Degree programs: