Returning Student Registration Form Please enable JavaScript in your browser to complete this form.Student InformationName *FirstMiddleLastEmail *Please enter your email, so we can follow up with you.Student Attendance Plan *Onsite Student ($233.33/mo)Online Student ($177/mo)Audit Student ($97/mo)InternshipAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long at this address in years?Mobile Phone *Home PhoneWork PhoneEmergency Contact InformationName of Emergency Contact *FirstLastEmergency Contact PhoneEmergency Contact RelationshipEmergency Contact EmailBackground InformationIs Redemption House Life Center your home church?YesNoIf not, where do you attend church?What are your spiritual passions?In what capacity are you currently serving?Tell us about your experiences with healings, miracles, signs, and wonders.Grant Information (optional)Birth DateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderMaleFemaleRaceWhiteBlack/African AmericaAsianAmerican IndianNative Hawaiian or Pacific IslanderAre you of Hispanic or Latino origin?YesNoNation of BirthCitizenshipUS CitizenNot a US CitizenNation of CitizenshipPhoneSubmit