Form A Continuing and Distance Education

It is only necessary to complete this application if you are pursuing an entire program through Continuing and Distance Education. If you would like to register for a single course, please fill out this form instead.

1. Please indicate your desired program:

Briercrest College:
Briercrest Seminary:

2. Personal Information

Title:
First name:
Last name:
Permanent Mailing Address:
Other names that may appear on your transcripts
(e.g. maiden, nicknames)
City: Province/State:
Postal/Zip Code: Country
Home Phone: - -
Cell Phone: - -
Work Phone: - -
Email Address:
 
Email address is:  
Social Insurance / Security Number:
Citizenship:
Date of Birth (mm/dd/yy): / /

3. Finances

What will you need to depend on to finance your education?

4. Statistical Data

Have you applied or will you be applying to any other schools this year? If so, which one(s)?
Have you visited our campus?
If yes, when and for which event?
How did you first hear about Briercrest?
What was the main factor that influenced you to apply?

5. Church Information

Name of local church you currently attend:
Complete Address:
Phone Number:
Denomination:
Senior Pastor: Alumnus of Briercrest?
Associate Pastor: Alumnus of Briercrest?
Youth Pastor: Alumnus of Briercrest?

6. Education

High School(s) Attended
Name of Institution City, Province/State Date(s) of AttendanceGrade Completed
Post-Secondary School(s) Attended
Name of Institution City, Province/State Date(s) of Attendance Programs or Courses Completed
Graduate School(s) Attended
Name of Institution City, Province/State Date(s) of Attendance Programs or Courses Completed

Payment Information (optional)

You can choose to submit your application fee online by entering in your credit card information below.
The application fee is $50.

Name as on Card
Card Type
Card Number
Expiry Date:

To the best of my knowledge the information provided on this form is accurate and truthful. I understand and accept that submission of this application does not imply my acceptance as a student, and that Briercrest College and Seminary retains the right to refuse my application in its sole discretion without further obligation to me. The personal information provided in this application, including Forms A, B, C and E, may be used by Briercrest employees and representatives for purposes that are appropriate for fulfilling the institutional mission and providing me with a quality education.

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