Berkley Academy Application

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Email *

Name (First, Middle Initial, Last)

Cell Phone Number

Address

Gender

Marital Status:

Single

Engaged

Married

Other:

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Are you a US Citizen?

Yes

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If you are under 18, please list the name, address, and phone number of your parents/guardians.

Please list your social media names (Facebook, Twitter, Instagram, etc)

What is the highest level of education you have received?

High School

High School Graduate

College

College Graduate

Other:

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What is the last High School you attended?

What was your final High School GPA? (or current if still in High School)

Do you currently attend Berkley Hills Church?

Yes

I attend a different church

I do not attend church

Other:

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If you attend a church, please describe your involvement in your church.

What degree path are you interested in? *

What program are you applying for? *

IWU@Berkley (online classes)

Ministry Development Program (High School Intern, College Intern, Apprentice, or Resident)

IWU@Berkley Enhanced Experience (online classes for ministry minded students)

Why do you feel Berkley Academy would be a good fit for you? *

How did you hear about Berkley Academy? *

Please list three references we can contact, including name, email, and phone number.

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) they have regarding my character In consideration of the receipt and evaluation of this application by Berkley Academy, I hereby release any individual, church, youth organization, reference, or any other person or organization (including record custodians) both collectively and individually, from any and all liability for damages of whatever kind of nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. I further stated that I have carefully read the foregoing release and know the contents thereof and I agree to this release as my own free act. This is a legally binding agreement, which I have read and understand.

I agree

I do not agree

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