Appalachian Conference IPHC - Credentialing Courses Registration

First Name

Last Name

Email

Address

CIty

State

Zip Code

Phone Number

Did you graduate high school?
Yes
No

Year of Completion

Name of School

If not, do you have an equivalent GED?
Yes
No

Please send a copy of this to Rhonda Smith at rhondawsmith@aol.com

Have you attended or completed any college?
Yes
No

Year of Completion

Name of School

Degree Earned (if applicable)

Have you every taken a MCCM class before?
Yes
No

If not, please make sure to pay the one time $35 registration fee on the credentialing courses homepage.

I hereby verify that I have read the instructions and requirements of the Maranatha College of Christian Ministries and will to the best of my ability, endeavor to honorably maintain the high quality and reputation of the school. The parties agree that this consent may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. Please type your full, legal name.

Credentialing Courses Registration Form

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