Page 55 - Revelation Message Christian Institute Catalog

REVELATION MESSAGE CHRISTIAN INSTITUTE

2121 Corporate Square Blvd. Suite 171-A
Jacksonville, FL 32216
(904)786-5383
Listen-Read-Be Educated-Be Equipped

___________________________________________
NAME OF FACILITATOR (NOT the Ministry)

APPLICATION FOR ADMISSION

I hereby request application to Revelation Message Christian Institute (RMCI); whereby, I may “study to
show myself approved to God, a workman that need not be ashamed.” I submit myself to the Lordship of
Jesus Christ, my Lord, and my Savior. I submit this application to Revelation Message Christian Institute
in the witness of God and in obedience to His call upon my life. I hereby declare I will fulfill His “calling”
upon my life, complete all studies as directed by the Lord and representatives of RMCI and enter the harvest
fields as a laborer for the GOSPEL MINISTRY of Jesus Christ.

STUDENT ID #________________________ (School Use Only)

PLEASE PRINT LEGIBLY

DATE OF APPLICATION: SOCIAL SECURITY NUMBER:

HOME PHONE NUMBER:( ) CELL PHONE NUMBER: ( )

DATE OF BIRTH: MALE: FEMALE:
(List all other last names used)
NAME OF (Dr., Pastor, Rev.
APPLICANT: Mr., Mrs., Ms.)
(Last) (First) (MI)
HOME ADDRESS:

CITY: STATE: ZIP:

WORK ADDRESS:

CITY: STATE: ZIP:

EMAIL ADDRESS:
Your acceptance package will be emailed to you.

 Please check this box if you would like to have access to the online program
 Please check this box if you would like to order a Student ID Card ($25.00)
 Please check if you would like to receive e-books when available for the courses
that require textbooks.

PLEASE ENCLOSE GOVERNMENT IDENTIFICATION (Driver’s License/State ID Card)
And RECENT PHOTO WITH A $50.00 APPLICATION FEE ($75.00 if requesting Student ID Card)

RMCI Catalog Appendix A A-3