Application for Admission
P.O. Box 1207, Citrus Heights, CA 95611
Phone: 916/924-1919; Fax: 916/924-1234
Web: www.Reyah.org – E-Mail: Contact@Reyah.org
2 Corinthians 2:14
Check List:
❑ Complete this APPLICATION FORM, print it out, and mail it to the above address.
❑ Write a CHECK or MONEY ORDER (or CASH if paying in person) for the $25 Application Fee payable to Reyah College (this is a non-refundable fee) and mail to the above address OR click on On-Line PayPal Payment and click on “PayPal Click Here to Pay” icon.
❑ To help us learn about you and to assess academic proficiency, please provide a one-page ESSAY on the form provided why you want to enroll in Reyah College and how you believe Reyah can help in your life goals.
1. Name:________________________________________________________________________________
Last Name First Name Middle Name Maiden Name (if applicable)
2. Gender: ❑ Male ❑ Female
3. Birth Date: Month______________________ Day______ Year___________
4. Social Security #:_________/_____/__________
5. Street Address:_________________________________________________________________________
6. City:__________________________________________________ State:______ Zip: ______________
7. Home Phone: (______)_______________________ Work Phone: (______)_______________________
8. Fax: (_______)_____________________________
9. E-Mail:_______________________________________________________________________________
Optional Information (no requirement to fill out this portion – purpose is for statistics only):
10. Marital Status: ❑ Married ❑ Single If married, Spouse’s Name: __________________________
11. Citizenship: ❑ U.S.A. ❑ Other:____________________________________________________
12. Ethnicity: ❑ African-American ❑ Asian/Pacific Islander ❑ Caucasian/White
❑ Hispanic ❑ Native American ❑ Other:____________________
Education Plan at Reyah College (Please check all that apply):
13. ❑ I wish to take an occasional course for spiritual enrichment.
14. ❑ I am interested in the 10-course Certificate for Biblical Foundations.
15. ❑ I am interested in the 20-course Associate in Bible and Theology.
(Includes Certificate for Biblical Foundations)
16. ❑ I am interested in the 20-course Associate in Leadership Ministries.
(Includes Certificate for Biblical Foundations)
17. ❑ I have or will have an A.A. or IGETC courses and am interested in the Bachelor in Bible and Theology.
18. ❑ I have or will have an A.A. or IGETC courses and am interested in the Bachelor in Leadership Ministries.
19. ❑ I am interested in completing educational requirements for ministerial credentialing.
20. ❑ I am interested in obtaining experiential learning to use for a portfolio in other colleges.
21. ❑ I plan to enter Reyah the semester of: ❑ Spring 2009 ❑ Summer 2009 ❑ Fall 2009
❑ Spring 2010 ❑ Summer 2010 ❑ Fall 2010
22. Comments:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Applicant’s Submission of Form:
By submitting this application for admission as a student to Reyah College, I declare I will not behave in any manner that may be considered disruptive at Reyah College.
By signing my name, I indicate I will abide by the preceding statement.
Name:_______________________________________________ Date:_______________________________
Mail to: Reyah College, P.O. Box 1207, Citrus Heights, CA 95611
NOTICE OF NONDISCRIMINATORY POLICY AS TO STUDENTS
The Reyah Group admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.