SOM Process – 5 – Pre-Enrollment Checklist for CIMS – Church of God Division of Education

Registration Date*

MM

DD

YYYY

Name*

First Middle Last

If you do not have a middle name, place an 'x' in the Middle Name field.

Social Security Number*

Ministerial Number

Phone Number*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I will be studying through:*

Internet
DVD
Distance Learning Center (DLC)
Distance Learning Seminar (DLS)

Distance Learning Center (DLC) or Distance Learning Seminar (DLS) location*

Please indicate yes or no that you:

Toured the educational facility?*

Yes
No

Received an institutional catalog.*

Yes
No

Was given the time and opportunity to review the institutional policies in the catalog.*

Yes
No

Has been informed of the length of the program for full-time and part-time students in the academic terms and actual calendar time.*

Yes
No

Has been informed of the total tuition and fee cost of the program.*

Yes
No

Has been informed of the estimated cost of books and any required equipment purchases such as a stenography machine, computer, specialized tools, art supplies, etc.*

Yes
No

Has been given a copy of the institutional cancellation and refund policy.*

Yes
No

Has been given the address and telephone number of Commission Staff [Tennessee Higher Education Commission, 404 James Robertson Parkway, Nashville, TN 37243-0830, (615) 741-5293]. along with a statement that reads: “Any person claiming damage or loss as a result of any act or practice by the Church of God School of Ministry that is in violation of the title 49, Chapter 7, Part 20 or Rule Chapter 1540-01-02-.13(1)(j) may file a complaint with the Tennessee Higher Education Commission, Division of Postsecondary State Authorization.”*

Yes
No

Has executed (signed) a Transfer of Credit Disclosure Statement in compliance with T.C.A. § 49-7-144 and understands the specific limitations should the institution have articulation agreements.*

Yes
No

For the program titled Certificate In Ministerial Studies (CIMS), I have been informed that for the period of July 2017–June 2018 period, the withdrawal rate is .0000%, the completion rate is .0017%, and the in-field placement rate is .0017%. Detailed statistical data for this program may be viewed by going to http://state.tn.us/thec and clicking on the “Authorized Institutions Data” button.*

Yes
No

Visit http://state.tn.us/thec

Signature

I, the student, have read and understood this document.*

Yes
No

Signature*

Date*