IPC THEOLOGICAL SEMINARY KOTTAYAMipcseminary.com/pdf/Residential_Application_Form.pdfApplication No: Form A IPC THEOLOGICAL SEMINARY KOTTAYAM Accredited by Asia Theological Association

Application No: ------------------ Form A

IPC THEOLOGICAL SEMINARY KOTTAYAM Accredited by Asia Theological Association Recognized by IPC General Council

A Project of IPC Educational and Welfare Society (Reg. No. K-18/2003)

P.O Box: 3, Puthuppally, Kottayam – 686 011

Email:[email protected]

Website: http://www.ipcseminary.com Ph: 0481-2351774, 2353040, 9497579772

APPLICATION FORM

Tick () the one that is applicable

FILL UP THE APPLICATION IN BLOCK LETTERS

1. Name of Applicant……………………………………………………………

2. Gender Male Female

3. Date of Birth………………………………………….

4. Place of Birth………………………………………… Nationality…………………………..

5. Marital Status Married Unmarried

6. Educational Qualifications

Diploma/

Degree

Seminary/College/

Board/University

Location Period of

Study

Percentage Awards if

Any

7. Address for Correspondence ………………………………………………………..……………………………………..

……………………………………………………..………………………………………………………………………………...

……………………………………………………..………………………………………………………………………………...

……………………………………………………..………………………………………………………………………………...

Telephone…………………………………………Mobile……………………………………E-mail…………………………….

Course Required Qualification Mode Duration

B.Th.

PDC/ +2 Passed

Regular

4 Years

B.Miss PDC/ +2 Regular 3 Years

M.Div.

Graduate of a recognized

University

B.Th with an average of 55%

(ATA/SSC)

Regular

3 Years

2 Years

Affix a Recent Photograph

http://www.ipcseminary.com/

8. Permanent Address………………………………………………………..………………………………………………………

……………………………………………………..………………………………………………………………………………...

……………………………………………………..………………………………………………………………………………...

……………………………………………………..………………………………………………………………………………...

9. Name of Father/Guardian……………………………………………………………………………………………………..

10. Name of Spouse…………………………………………………………………………………………………………….

11. Number of Children…………………………………………………………………………………………………………….

Name Date of Birth

12. When did you accept Jesus Christ as your Personal Savior? …………………………………………………………….

13. Have you taken Believer’s Baptism? Give Date with Details………………………………………………………………….

………………………………………………………………………………………………………………………………….

14. Have you experienced the infilling of the Holy Spirit? If yes, give the date…………………………………………………..

15. Church Affiliation …………………………………………………………………………………………………………..

16. Local Address ………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………….

17. Head Quarters Address ………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………….

18. How long have you been a member?.......................................................................................................................... ................

19. Your involvement in the ministry of your Local Church. Give details.

………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………….

20. What are your involvements in other ministries? Give details.

……………………………………………………………………………………………………………………………..

21. Are you ordained? Yes No

If yes, give details………………………………………………………………………………………………………….

22. Proficiency in Languages

Language Understand Speak Read Write

English

Hindi

23. Give details of your work/ministry after your studies till today.

Type of Work/

Ministry

Duration Place Name& Address of the

Institution

24. Do you have any other Professional skills? Yes / No

If Yes, Specify the name of Degree/Diploma & the type of job you do

……………………………………………………………………………………………………………………………

25. Have you ever had to discontinue any course or studies? Yes/No.

If yes, state why………………………………………………………………………………………………………….

26. Give the names and complete address of your Pastor and two Christian Leaders, who you know well (not your relatives) :

Your Local Pastor………………………………………………..

……………………………………………………………………

……………………………………………………………………

Two Christian Leaders

1. ……………………………………………………………………

……………………………………………………………………

……………………………………………………………………

……………………………………………………………………

2. ……………………………………………………………………

……………………………………………………………………

……………………………………………………………………

……………………………………………………………………

I ………………………………………………….. (Block Letters) declare that all the information given in the

application form is true and correct .I understand that any information , which I have furnished above ,if proved to be

false or incorrect, will automatically disqualify me from being admitted to, or continuing in IPCTSK.

a. I shall maintain high academic standard and a spirit of unity and love.

b. I shall abide by IPCTSK rules and regulations.

c. I shall submit to the right of the IPCTSK administration to take any action, if in their judgment, my

behavior, character or doctrine is contrary to the spirit &emphasis of IPCTSK.

d. I understand that IPCTSK sets high academic, moral and social standards. I shall accept and abide by the

decisions of the IPCTSK, including the possible termination of my study in IPCTSK if after written

warning; I do not measure up to IPCTSK standards, academic or pastoral.

e. I shall on completion of my graduation requirements (academic and others)serve a minimum of one year of

internship in a place/ministry agreeable to the Seminary; if I receive any financial assistance for my studies

at IPCTSK( Only applicable for regular in Programmes)

Place…………………………… Signature……………………………

Date…………………………… Name……………………………….

FOR OFFICE USE ONLY Date of the receipt of application :………………………………………………………………………………………………………………

Result of screening : Approved/ Denied

Result of interview & written Exam : Admit/ Wait list/ Reject

Intimation of admission sent on :………………………………………………………………………………………………………………

Date of admission & No :………………………………………………………………………………………………………………

Course Admitted to :………………………………………………………………………………………………………………

Date of leaving / removal/ graduation :………………………………………………………………………………………………………………

Degree awarded :………………………………………………………………………………………………………………

Remarks :………………………………………………………………………………………………………………

Principal Dean of Academics

Application No -----------/------------ Form B

IPC THEOLOGICAL SEMINARY KOTTAYAM

P.O Box: 3, Puthuppally, Kottayam – 686 011, Kerala, S. India

APPLICANT’S STATEMENT OF PURPOSE

1. List three expectations you have of theological education.

1. 2. 3.

2. Why did you select IPCTSK for your studies?

3. What type of Christian ministry do you expect to do on completion of your studies at IPCTSK?

4. Describe your Christian experience (Born again, Water baptism, In-filling of the Holy Spirit, Call & Commitment for ministry). Please use extra sheets if necessary

Place ------------------------- Signature --------------------------- Date ---------------------------- Name ---------------------------------

Application No -----------/------------ Form C



MEDICAL CERTIFICATE (To be filled by a Registered Medical Practitioner)

Name: …………………………………………………………………………………………………

Date of Birth ………………………… Male/ Female ………………………………………………

Height ………………………… Weight ………………………………………………

General : ENT

Eyes ………………………… Skin ………………………………………………

Skeletal ………………………… CVS ………………………………………………

R.S ………………………… Abdomen ………………………………………………

CNS ………………………… Blood Pressure ………………………………………………

Family History

Blood Dyscrasia ………………………… Diabetes ………………………………………………

Hypertension ………………………… Asthma ………………………………………………

Past

Jaundice ………………………… Operations ………………………………………………

Epilepsy ………………………… Long term Treatment ……………………………………

Allergy to any drugs ……………………………………………………………………………………………

Intolerance or allergy to any food …………………………………………………………………………………

Laboratory Reports

Blood groups ………………………… Rh +ve/ -ve …………………………………………...

Hemoglobin ………………………… Serology …………………………………………...

Urine ………………………… Glucose Tolerance …………………………………………...

Chest X- Ray/ Screen ……………………….……...……...……...……...……...……...……...……...……...…

Immunization

Typhoid ………………………… Tetanus ……………………… Cholera ………………

Past treatment & recommendation ……………………….……...……...……...……...……...……...……...…

Are you on any long term medication? Or have you been on long term medication? If so, please supply a medical report.

Date …………………………………. ……………………………………………

(Signature of the Doctor)

Reg. No …………………………………………...……..…

Address …………………………………………...……..…

…………………………………………...……..…

Application No. -------------/------ Form D



SPONSOR’S FINANCIAL COMMITMENT / MINISTERIAL COMMITMENT (Application will not be processed if this form is not filled)

Name of Applicant -----------------------------------------------------------------------------------

Tick the appropriate

A. Financial and Ministerial Guarantee

We hereby undertake to pay the full fee of the above student for the entire period of his/her study at

IPCTSK by arranging to transfer our committed amount to the IPCTSK Bursar, either in full or in

instalments on or before the specified dates. We also assure you that this candidate will work with us

upon completion of his/her studies as a

□ Missionary to North India

□ Pastor in the Church

□ Pioneering work in Kerala

□ To work as a teacher/ in our institution

B. Financial Guarantee only

We hereby undertake to pay the full fees of the above student for the entire period of study at IPCTSK by

arranging to transfer our commitment to the IPCTSK Account, either in full or in instalments on or before

the specified dates.

C. Financial Assistance

We hereby undertake to financially support the above student to the amount of ________annually

for the entire period of study at IPCTSK by arranging to transfer our committed amount to the IPCTSK

Account, either in full or installment on or before the specified dates. For details Contact: 9497579772

NOTE: Under no circumstances will IPCTSK be able to advance funds for personal needs.

OFFICE Sponsor’s Signature -------------------------------------

STAMP Designation -----------------------------------------------

Please furnish the name and address of the person to whom the bills of fee should be sent for payment (IN

BLOCK LETTERS)

Names ---------------------------------------------------------

Address --------------------------------------------------------

---------------------------------------------------------

---------------------------------------------------------

---------------------------------------------------------

Place -------------------------------------

Date --------------------------------------

Application No. -------------/------ Form E-1


P.O Box: 3, Puthuppally, Kottayam – 686 011, Kerala, India

LETTER OF RECOMMENDATION / ACADEMIC REFERENCE STRICTLY CONFIDENTIAL (To be sent directly to IPCTSK)

(To be filled by the head of the previous institution where the applicant has studied)

Name of the Applicant ………………………………………………………………………………………… Name of the Referee …………………………………………………………………………………………... As IPCTSK is training men and women for a lifetime of Christian work and ministry, it needs to take utmost care in selecting applicants. So please give adequate information on the applicant’s strengths and weaknesses which is very important for our decision making. If you need extra space for any item, please use a separate sheet of paper. All information given will be kept strictly confidential. Kindly send this form directly to the Academic Dean. Thank you for your help.

1. How long have you known the applicant?

2. In what capacity have you known him/her?

3. How would you appraise the applicant’s abilities in the following areas?

Not observed Poor Average Good Outstanding

Intellectual

Relationship with others

Creative thinking Social Congeniality Proficiency in English Written communication skills Oral communication skills Mental cognizance Leadership skills Attitude to authority Organization Moral life Behavioral Maturity Personal Relation

4. Kindly use this space to make any additional remarks pertaining to the applicant’s strengths and weaknesses that might be helpful in appraising this applicant for admission.

5. Do you recommend this applicant for studies at IPC Theological Seminary Kottayam? (Tick the appropriate)

□ strongly recommend

□ recommend

□ Recommend with reservation

□ don’t recommend

Signature : ----------------------------------------------- Official Stamp Designation: ---------------------------------------------- Place: --------------------------- Date: ----------------------------

Please send this to: The Dean of Academics,IPCTSK, P.O. Box 3, Puthuppally, Kottayam 686 011, Kerala,.India

Application No. -------------/------ Form E-2



LETTER OF RECOMMENDATION/SPIRITUAL REFERENCE STRICTLY CONFIDENTIAL (To be sent directly to IPCTSK)

(To be filled by the senior pastor of the applicant’s Church Head Quarter)

Name of the Applicant ………………………………………………………………………………………… Name of the Referee …………………………………………………………………………………………... As IPCTSK is training men and women for a lifetime of Christian work and ministry, it needs to take utmost care in selecting applicants. So please give adequate information on the applicant’s strengths and weaknesses which is very important for our decision making. If you need extra space for any item, please use a separate sheet of paper. All information given will be kept strictly confidential. Kindly send this form directly to the Academic Dean. Thank you for your help.

1. How long have you known the applicant?

2. In what capacity have you known him/her?

3. What do you know about the applicant’s personal commitment to Christ?

4. What is the nature of the applicant’s present assignment/appointments?

5. What spiritual gifts and talents do the applicant posses?

6. Spiritual maturity (tick the appropriate)

Not observed Poor Average Good Outstanding

Christian Life Relationship to spouse/family Prayer Life Bible knowledge Acceptance in the society Preparedness to face hardship

Openness to new ideas

Moral life

Emotional maturity Stewardship Personal relation Integrity Attitude towards service Patience

7. Kindly use this space to make any additional remarks pertaining to the applicant’s strengths and weaknesses that might be helpful in appraising this applicant for admission.

8. Do you recommend this applicant for studies at IPC Theological Seminary Kottayam? (Tick the appropriate)

□ Strongly recommend

□ Recommend

□ Recommend with reservation

□ Don’t recommend

Signature : -----------------------------------------------

Official Stamp Designation: ---------------------------------------------- Place: --------------------------- Date: ----------------------------

Please sent this to: The Dean of Academics, IPCTSK, P.O. Box 3, Puthuppally, Kottayam 686 011, Kerala, S.India

IPC THEOLOGICAL SEMINARY KOTTAYAMipcseminary.com/pdf/Residential_Application_Form.pdfApplication No: Form A IPC THEOLOGICAL SEMINARY KOTTAYAM Accredited by Asia Theological Association

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