Claremont School of Theology

1325 North College Avenue, Claremont, CA 91711 Telephone: 909-447-2507

Toll Free: 866-274-6500 Fax: 909-626-7062 Email: admission@cst.edu Web: www.cst.edu

APPLICATION FOR ADMISSION – M.Div. and M.A. Degree Programs

The information requested on this form, as well as accompanying application materials, will be carefully reviewed by the Admission Committee and therefore should be typed or neatly printed.

I AM APPLYING FOR THE

□ M.Div. □ M.A. □ M.A.P.C. □ M.A.R.E. □ Joint M.Div. with ETSC

I AM APPLYING FOR ADMISSION Fall , January Interterm , Spring , Summer

PERSONAL DATA

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NAME (LAST, FIRST MIDDLE) SOCIAL SECURITY NUMBER

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UNDER WHAT OTHER LAST NAME(S) MIGHT DOCUMENTS BE RECEIVED? PREFERRED LAST NAME

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CURRENT MAILING ADDRESS (STREET ADDRESS)

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(CITY, STATE, ZIP) TELEPHONE (HOME/CELL)

________________________________________________________________________________________________________________

EFFECTIVE UNTIL TELEPHONE (WORK)

________________________________________________________________________________________________________________

PERMANENT MAILING ADDRESS (STREET ADDRESS)

________________________________________________________________________________________________________________

(CITY, STATE, ZIP) TELEPHONE NUMBER

________________________________________________________________________________________________________________

E-MAIL ADDRESS (THIS IS IMPORTANT FOR ALL APPLICANTS, PARTICULARLY INTERNATIONAL STUDENTS)

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COUNTRY OF CITIZENSHIP OR LEGAL PERMANENT RESIDENCE

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DATE OF BIRTH (MONTH/DAY/YEAR) PLACE OF BIRTH (CITY, STATE, COUNTRY)

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IF NOT A U.S. CITIZEN, SPECIFY TYPE OF VISA IF PERMANENT RESIDENT, GIVE ALIEN REGISTRATION NUMBER

GENDER (This information will be used only in accordance with Title IX of the Education Amendments of 1972.)

□ Male □ Female

PREDOMINANT RACIAL/ETHNIC BACKGROUND

(This information will be used only in accordance with Title VI of the Civil Rights Act of 1964.)

□ Native American/Alaskan Native □ Hispanic/Latino

□ Asian □ Native Hawaiian/Pacific Islander □ Other___________________

□ Black/Non-Hispanic □ White/Non-Hispanic □ International Student

MARITAL STATUS (Optional. This information is used to project possible housing needs.) __________

RELIGIOUS AFFILIATION

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DENOMINATION / RELIGION

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LOCAL CONGREGATION NAME PASTOR’S NAME

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LOCAL CONGREGATION ADDRESS TELEPHONE NUMBER

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INDICATE LOCAL CONGREGATION ACTIVITIES, PAID OR VOLUNTARY, DURING THE PAST FIVE YEARS.

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YOUR CURRENT STATUS, IF ANY, WITH YOUR DENOMINATION (i.e. certified candidate, under care, ordained, etc.).

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IDENTIFY THE JUDICATORY (ANNUAL CONFERENCE, JUDICATORY, PRESBYTERY, ETC.) WITH WHICH YOU ARE AFFILIATED OR WILL AFFILIATE AFTER M.DIV.

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IDENTIFY A SPECIFIC AREA IN WHICH YOU WOULD LIKE TO CONCENTRATE YOUR STUDY AT CLAREMONT.

EDUCATION

List chronologically all colleges, universities, and seminaries attended. Attach a separate sheet if necessary. Official transcripts from all schools are required for admission.

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SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

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SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

ADDITIONAL INFORMATION

Explain how you first heard about Claremont School of Theology. __________________________________

With which Claremont faculty or staff have you discussed your admission? ___________________________

Have you visited the Claremont campus? □ YES □ NO

To which other theological schools are you applying? ___________________________________________

Do you plan to study full-time or part-time? __________________________________________________

Will you be applying for financial aid? □ YES □ NO (Claremont’s FAFSA Code number is 001288)

Will you need an apartment on-campus? □ YES □ NO

EMERGENCY CONTACT Identify a person who may be contacted in case of an emergency.

________________________________________________________________________________________________________________

NAME

________________________________________________________________________________________________________________

ADDRESS (STREET, CITY, STATE, ZIP)

________________________________________________________________________________________________________________

RELATIONSHIP TO YOU TELEPHONE NUMBER

________________________________________________________________________________________________________________

SIGNATURE OF APPLICANT DATE

Claremont School of Theology

1325 North College Avenue, Claremont, CA 91711 Telephone: 909-447-2507

Toll Free: 866-274-6500 Fax: 909-626-7062 Email: admission@cst.edu Web: www.cst.edu

APPLICATION FOR ADMISSION – D.Min. Degree Program

The information requested on this form, as well as accompanying application materials, will be carefully reviewed by the Admission Committee and therefore should be typed or neatly printed.

I AM APPLYING FOR ADMISSION Fall ________

PERSONAL DATA

________________________________________________________________________________________________________________

NAME (LAST, FIRST MIDDLE) SOCIAL SECURITY NUMBER

________________________________________________________________________________________________________________

UNDER WHAT OTHER LAST NAME(S) MIGHT DOCUMENTS BE RECEIVED? PREFERRED LAST NAME

________________________________________________________________________________________________________________

CURRENT MAILING ADDRESS (STREET ADDRESS)

________________________________________________________________________________________________________________

(CITY, STATE, ZIP) TELEPHONE (HOME/CELL)

________________________________________________________________________________________________________________

EFFECTIVE UNTIL TELEPHONE (WORK)

________________________________________________________________________________________________________________

PERMANENT MAILING ADDRESS (STREET ADDRESS)

________________________________________________________________________________________________________________

(CITY, STATE, ZIP) TELEPHONE NUMBER

________________________________________________________________________________________________________________

E-MAIL ADDRESS (THIS IS IMPORTANT FOR ALL APPLICANTS, PARTICULARLY INTERNATIONAL STUDENTS)

________________________________________________________________________________________________________________

COUNTRY OF CITIZENSHIP OR LEGAL PERMANENT RESIDENCE

________________________________________________________________________________________________________________

DATE OF BIRTH (MONTH/DAY/YEAR) PLACE OF BIRTH (CITY, STATE, COUNTRY)

________________________________________________________________________________________________________________

IF NOT A U.S. CITIZEN, SPECIFY TYPE OF VISA IF PERMANENT RESIDENT, GIVE ALIEN REGISTRATION NUMBER

GENDER (This information will be used only in accordance with Title IX of the Education Amendments of 1972.)

□ Male □ Female

PREDOMINANT RACIAL/ETHNIC BACKGROUND

(This information will be used only in accordance with Title VI of the Civil Rights Act of 1964.)

□ Native American/Alaskan Native □ Hispanic/Latino

□ Asian □ Native Hawaiian/Pacific Islander □ Other___________________

□ Black/Non-Hispanic □ White/Non-Hispanic □ International Student

MARITAL STATUS (Optional. This information is used to project possible housing needs.) __________

PROGRAM INFORMATION (Identify the area in which you would like to concentrate.)

□ Hebrew Bible □ New Testament □ Theology

□ History of Christianity □ Ethics □ World Religions □ Interfaith Studies, □ Leadership Studies

□ Evangelism and Mission □ Preaching and Worship □ Religious Education

□ Pastoral Care and/or Counseling □ Urban Ministry □ Other __________________________

RELIGIOUS AFFILIATION

________________________________________________________________________________________________________________

DENOMINATION / RELIGION

________________________________________________________________________________________________________________

LOCAL CONGREGATION NAME PASTOR’S NAME

________________________________________________________________________________________________________________

LOCAL CONGREGATION ADDRESS TELEPHONE NUMBER

________________________________________________________________________________________________________________

INDICATE LOCAL CONGREGATION ACTIVITIES, PAID OR VOLUNTARY, DURING THE PAST FIVE YEARS.

________________________________________________________________________________________________________________

IDENTIFY THE JUDICATORY (ANNUAL CONFERENCE, JUDICATORY, PRESBYTERY, ETC.) WITH WHICH YOU ARE AFFILIATED.

MINISTERIAL EMPLOYMENT/PASTORATES

Please list pastorates held or institutions served during the past five years. Attach additional sheets if necessary.

________________________________________________________________________________________________________________

CHURCH/INSTITUTION LOCATION □ FULL-TIME □ PART-TIME

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CHURCH/INSTITUTION LOCATION □ FULL-TIME □ PART-TIME

EDUCATION

List chronologically all colleges, universities, and seminaries attended. Attach additional sheets if necessary. Official transcripts from all schools are required for admission.

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

ADDITIONAL INFORMATION

Explain how you first heard about Claremont School of Theology. __________________________________

With which Claremont faculty or staff have you discussed your admission? ___________________________

To which other theological schools are you applying? ___________________________________________

Do you plan to study full-time or part-time? __________________________________________________

Will you be applying for financial aid? □ YES □ NO (Claremont’s FAFSA Code number is 001288)

Will you need an apartment on-campus? □ YES □ NO

EMERGENCY CONTACT Identify a person who may be contacted in case of an emergency.

________________________________________________________________________________________________________________

NAME

________________________________________________________________________________________________________________

ADDRESS (STREET, CITY, STATE, ZIP)

________________________________________________________________________________________________________________

RELATIONSHIP TO YOU TELEPHONE NUMBER

________________________________________________________________________________________________________________

SIGNATURE OF APPLICANT DATE

Claremont School of Theology

1325 North College Avenue, Claremont, CA 91711 Telephone: 909-447-2507

Toll Free: 866-274-6500 Fax: 909-626-7062 Email: admission@cst.edu Web: www.cst.edu

APPLICATION FOR ADMISSION – Ph.D. Degree Program

The information requested on this form, as well as accompanying application materials, will be carefully reviewed by the Admission Committee and therefore should be typed or neatly printed.

I AM APPLYING FOR ADMISSION Fall ________

I WISH TO CONSENTRATE IN □ Pastoral Care & Counseling □ Religious Education

PERSONAL DATA

________________________________________________________________________________________________________________

NAME (LAST, FIRST MIDDLE) SOCIAL SECURITY NUMBER

________________________________________________________________________________________________________________

UNDER WHAT OTHER LAST NAME(S) MIGHT DOCUMENTS BE RECEIVED? PREFERRED LAST NAME

________________________________________________________________________________________________________________

CURRENT MAILING ADDRESS (STREET ADDRESS)

________________________________________________________________________________________________________________

(CITY, STATE, ZIP) TELEPHONE (HOME/CELL)

________________________________________________________________________________________________________________

EFFECTIVE UNTIL TELEPHONE (WORK)

________________________________________________________________________________________________________________

PERMANENT MAILING ADDRESS (STREET ADDRESS)

________________________________________________________________________________________________________________

(CITY, STATE, ZIP) TELEPHONE NUMBER

________________________________________________________________________________________________________________

E-MAIL ADDRESS (THIS IS IMPORTANT FOR ALL APPLICANTS, PARTICULARLY INTERNATIONAL STUDENTS)

________________________________________________________________________________________________________________

COUNTRY OF CITIZENSHIP OR LEGAL PERMANENT RESIDENCE

________________________________________________________________________________________________________________

DATE OF BIRTH (MONTH/DAY/YEAR) PLACE OF BIRTH (CITY, STATE, COUNTRY)

________________________________________________________________________________________________________________

IF NOT A U.S. CITIZEN, SPECIFY TYPE OF VISA IF PERMANENT RESIDENT, GIVE ALIEN REGISTRATION NUMBER

GENDER (This information will be used only in accordance with Title IX of the Education Amendments of 1972.)

□ Male □ Female

PREDOMINANT RACIAL/ETHNIC BACKGROUND

(This information will be used only in accordance with Title VI of the Civil Rights Act of 1964.)

□ Native American/Alaskan Native □ Hispanic/Latino

□ Asian □ Native Hawaiian/Pacific Islander □ Other___________________

□ Black/Non-Hispanic □ White/Non-Hispanic □ International Student

MARITAL STATUS (Optional. This information is used to project possible housing needs.) __________

PROGRAM INFORMATION

The Ph.D. requires residence at the Claremont campus. How many semesters are you planning to be in residence to complete your course work? ______________________________________________________________________

Pastoral Care and Counseling Applicants Designate your area of concentration:

□ Pastoral Counseling/Psychotherapy □ ACPE Supervision □ Clinical Pastoral Care

One unit of Clinical Pastoral Education (CPE) is required for admission. Name your supervisor and dates of completion and submit a copy of your CPE evaluation.

________________________________________________________________________________________________________________

SUPERVISOR’S NAME LOCATION DATES

If you are applying for the ACPE Supervision track, also submit a Letter of Readiness for Supervisory Training report from your most recent CPE center.

EDUCATION

List chronologically all colleges, universities, and seminaries attended. Attach a separate sheet if necessary. Official transcripts from all schools are required for admission.

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

________________________________________________________________________________________________________________

SCHOOL DATES ATTENDED DEGREE/DATE GRANTED

ADDITIONAL INFORMATION

Explain how you first heard about Claremont School of Theology. ___________________________________

Which Claremont faculty or staff have you communicated concerning your admission? ____________________

Have you visited the Claremont campus? □ YES □ NO

To which other theological schools are you applying? ____________________________________________

Do you plan to study full-time or part-time? ___________________________________________________

Will you be applying for financial aid? □ YES □ NO (Claremont’s FAFSA Code number is 001288)

Will you need an apartment on-campus? □ YES □ NO

EMERGENCY CONTACT Identify a person who may be contacted in case of an emergency.

________________________________________________________________________________________________________________

NAME

________________________________________________________________________________________________________________

ADDRESS (STREET, CITY, STATE, ZIP)

________________________________________________________________________________________________________________

RELATIONSHIP TO YOU TELEPHONE NUMBER

________________________________________________________________________________________________________________

SIGNATURE OF APPLICANT DATE

Claremont School of Theology

1325 North College Avenue, Claremont, CA 91711 Telephone: 909-447-2507

Toll Free: 866-274-6500 Fax: 909-626-7062 Email: admission@cst.edu Web: www.cst.edu

APPLICATION FOR ADMISSION – Non-Degree Status