_Evaluation Form for Credit hours to be Awarded

Name: _______________________________________________________________

Address: _____________________________________________________________

______________________________________________________________________


Telephone: ______________________ Email: ______________________


Christian Education
Bible Institute, College, Seminary Name(s)

___________________________________________

___________________________________________

___________________________________________


Courses (Please provide transcripts.)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Christian Experience
Please include all of your Christian Experience here. Positions such as Pastor, Assistant Pastor, Elder, Evangelist, Sunday School Administrator, Sunday School Teacher (include ages of children), Sunday School Secretary, Youth Director, or any office that you may have held. Include the years you have served Jesus Christ, sang in the choir, or music you have played. If you have been involved in an organization work, please include offices and years held, etc.
1.                                                                                                                                                   Yrs. _____
2.                                                                                                                                                   Yrs. _____
3.                                                                                                                                                   Yrs. _____
4.                                                                                                                                                   Yrs. _____
5.                                                                                                                                                   Yrs. _____
6.                                                                                                                                                   Yrs. _____
7.                                                                                                                                                   Yrs. _____
8.                                                                                                                                                   Yrs. _____
9.                                                                                                                                                   Yrs. _____
10.                                                                                                                                                 Yrs. _____



Secular Education

Trade School(s) College(s) University(s)  __________________________ Dates Attended ______________

__________________________  _______________

__________________________  _______________


Courses (Please provide transcripts)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Secular Experience
This page is for all your job experiences, your professional education, plus years of service
to each position (plumber, electrician, carpenter, etc.) Include your total work
experience. Include any community activities (Fireman, Boy Scout Leader, Etc.) Include
all training programs that you have been involved in (CPR Training, Drug Control Education, etc.)

1.                                                                                                                                                  Yrs. _____
2.                                                                                                                                                  Yrs. _____
3.                                                                                                                                                  Yrs. _____
4.                                                                                                                                                  Yrs. _____
5.                                                                                                                                                  Yrs. _____
6.                                                                                                                                                  Yrs. _____
7.                                                                                                                                                  Yrs. _____
8.                                                                                                                                                  Yrs. _____
9.                                                                                                                                                  Yrs. _____
10.                                                                                                                                                Yrs. _____





I hereby agree that all I have written are factual and are truly stated to the best of my knowledge.

Signature: ____________________________________ Date: __________________

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