Davis College Online Courses or On Campus in New York: A Distinctly Christian Values-Based Accredited College of Ministry

Online Registration Form

for

| Main Campus Summer Modules & Evening Courses | Adult Teaching Sites |

If you are interested in Accredited Online Courses through Davis College Click Here

Personal Information

Full Name:
Date of Birth (MM/DD/YY):
Home Address:
City, State, Zip:
County of Residence:
State of Residence:
Citizenship (Country):
Gender:	Male Female
Daytime Phone:
Evening Phone:
Social Security Number:
Email:
School or College Name:
What grade are you entering into?:
Lodging Needed (Johnson City Campus Only)?	Yes No

Course Location

Main Campus Fall Evening Courses

	September 12 - October 17, 2008 (Fridays), Albany, Music Appreciation MUSC 2011 at Mid-America Baptist Theological Seminary
	September 16 - December 4, 2008 (Thursdays), Albany, Basic Concepts in Math at Mid-America Baptist Theological Seminary
	January 8 - 10, 2009 (Intensive), Albany, Intro to Philosophy at Faith Baptist Church in Rexford, NY

Course Information

Course Name(s)	Day and Time	Please indicate if you are taking the course for credit or audit:

Immunizations: ALL students born after January 1, 1957 registered for 6 credits or more must show proof of immunity to Measles, Mumps & Rubella. This includes credits taken on the main campus, any teaching site, online courses, independent study or any combination of the above totaling 6 credits or more. Check with Student Health for the specifics of this requirement.

Statistical Profile:

Marital Status:

Denominational Affiliation:

If you chose "Other", what is your denomination or affiliation?

Race/Ethnic Origin:

How did you find out about Davis College?

Information about race/ethnicity is used for statistical purposes only. Davis College does not discriminate on the basis of race, color or national or ethnic origin in the admission of students or administration of educational programs.

Note: By clicking on "Send My Info!" I affirm that the information on this registration form is correct and accurate, and accept responsibility for being registered for the courses listed above for the coming semester at Davis College.