Academy Application | New Bethel Baptist Church

Thank you for your interest in The Academy at New Bethel Baptist Church. Please complete the application below, and a member from our team will be in touch. For additional information, reach out to academy@newbetheldc.org.

Contact Information

First Name First Name is required

Last Name Last Name is required

Address Address is required

City City is required

State State is required

Zip Code Zip Code is required

Phone Number Please enter a 10 digit phone number

Email Please enter a valid email address

What certificate program are you applying for? What certificate program are you applying for? is required

Preferred Start Date Please enter a valid date

Background Information

Date of Birth Please enter a valid date

What is the name of your church home?

Pastor/Spiritual Mentor Name

Pastor/Spiritual Mentor Email Address Please enter a valid email address

Pastor/Spiritual Mentor Phone Number Please enter a 10 digit phone number

Educational Background

Highest Level of Education Completed Highest Level of Education Completed is required

Institution Name

Graduation Year

Experience and Interests

Describe you ministry & church Involvement. Describe you ministry & church Involvement. is required

Why are you interested in a certificate program? Why are you interested in a certificate program? is required

References

Reference Name Reference Name is required

Reference Relationship Reference Relationship is required

Reference Email Address Please enter a valid email address

Reference Phone Number Please enter a 10 digit phone number

Reference Name Reference Name is required

Reference Relationship Reference Relationship is required

Reference Email Address Please enter a valid email address

Reference Phone Number Please enter a 10 digit phone number

Additional Information

List any special accommodations needed.

Additional comments or questions:

I certify my information is accurate. I certify my information is accurate. is required

Contact Information

Background Information

Educational Background

Experience and Interests

References

Additional Information

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