2nd Year Student Application

Personal Information
Name*
First Last
Preferred Name
Email Address*
Enter Email Confirm Email
Mobile Telephone*
Gender*
- Male
- Female
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Marital Status*
Name of Spouse or Fiancé
Date of Marriage
Date Format: MM slash DD slash YYYY
Number of Children
Employment
Company Name*
Start Date*
Date Format: MM slash DD slash YYYY
Location*
Role / Title*
Will you continue working during the school year?*
Finances
How do you plan to pay the financial obligation of tuition?*
What percentage of tuition do you currently have?*
Please enter a number from 0 to 100.
Will you be applying for a payment plan?*
- Yes
- No
If you do not have the full amount for tuition, how do you plan to raise the funds needed to fulfill the financial obligation of tuition?*
If you would like to apply for a scholarship, please fill in this application form with the application fee then send an email to hssmadmin@harvestnetintl.com
Please include your name, date of application and the motivation for applying for a scholarship.
Health
In the case of a medical emergency what is the name and contact number of a close family member or friend?*
What is your relationship to this person?*
Do you have a physical disability? If yes, please describe*
Have you ever received a diagnosis of any disease or cancer? If so, please describe*
Have you ever been treated, or been recommended to receive treatment, for any mental or emotional condition? If so, please describe
Please list any medications you are currently taking and for what purpose*
Please list any allergies to food, medicine, etc*
Medical Insurance Provider*
Policy #*
Phone Number
Other than a toll free number, if possible
How would you describe your temperament?*

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Church History
Home Congregation*
Pastor's Name*
List the name of the church that your membership is presently recorded.*
List the names of other churches you have regularly attended in the past five years.*
Give a general summary of the ministries you have been involved in for the past five years.*
Give a general summary of the areas of service outside the church in which you have been involved.*
Why are you applying for the 2nd year program?*
What are some of your personal expectations and goals for the year?*
Applicant's Statement
I, the undersigned, verify that to the best of my knowledge, the information contained in this application is correct. If in the evaluation of the Senior Pastor, it would be considered advisable to secure additional input from the church(es) listed, I hereby authorize such action and verify that I have read HNI’s child protection policy. I understand that background checks will be done to affirm that the information is correct.
Signature
Date
Date Format: MM slash DD slash YYYY

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HSSM Application Fee - 2nd year*
Application Fee
$0.00
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

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2nd Year Student Application

Personal Information

Employment

Finances

Health

Church History

Applicant's Statement

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