ENRICHMENT APPLICATION Enrichment courses at Pacific Rim Christian University are intensive courses not taken for credit. Acceptance is based on space available, as regular degree seeking students have first priority. The application fee of $89 is the fee for the course and will be reimbursed if we are unable to accommodate you. Contact pacrim.edu, 808-853-1040, [email protected], with further questions. INTENSIVE COURSE PROFILE PICTURE ☐SPRING 2015 – March 16-20: GM 2340 Bible and Pop Culture Please include a photo that can be used as your profile picture on Populi. This photo may also be used as your nametag once enrolled in school. ☐SPRING 2015 – March 16-20: LD 4309 Servant Leadership ☐SUMMER 2015 – May 18-22: Hermeneutics- Interpreting the Psalms ☐SUMMER 2015 – June 8-19: A New Vision for the Church ☐SUMMER 2015 – June 22-26: Moral Authority and Leadership BIOGRAPHICAL INFORMATION LEGAL NAME ________________________________________________________________________________________________ Last/Family/Sur (Enter name exactly as it appears on official documents) First/Given Middle (complete) Jr., etc. PREFERRED NAME ____________________________________ FORMER LAST NAME(S) _____________________________ US SOCIAL SECURITY NUMBER _________-_______-_________ BIRTH DATE _____________________ ☐ MALE ☐ FEMALE Required for US Citizens and Permanent Residents applying for financial aid via FAFSA mm/dd/yyyy TELEPHONE (____)____-_______ E-MAIL ADDRESS ________________________________ HOME CITY, STATE_______________ PERMANENT HOME ADDRESS _________________________________________________________________________________ Number & Street Apartment # ____________________________________________________________________________________________________________ City/Town County or Parish State/Province Country ZIP/Postal Code HAWAII MAILING ADDRESS, if different from above _________________________________________________________________ Number & Street Apartment # ____________________________________________________________________________________________________________ City/Town County or Parish State/Province Country ZIP/Postal Code Disciplinary History 1) Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9 grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. ☐ Yes ☐ No th 2) Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? ☐ Yes ☐ No (Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded or otherwise ordered by a court to be kept confidential.) If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience. PACIFIC RIM CHRISTIAN UNIVERSITY HOW DID YOU LEARN ABOUT PacRim? ☐Church ☐Friend ☐High School ☐Ministry ☐Website ☐Brochure ☐College Fair ☐Other ______________________________________ ☐NACCAP ☐Conference HOW WERE YOU REFERRED? If you heard from a family/friend, church, college fair, or internet search please indicate specifically which one. _________________________________________________________________________________________ FEES AND SUBMISSION APPLICATION FEE $89, checks payable to NEW HOPE CHRISTIAN COLLEGE - HAWAII or pay online through the online application at pacrim.edu ☐Online Payment ☐Will Mail Payment ☐Payment Attached APPLICATION IS ALSO AVAILABLE ONLINE AT PACRIM.EDU PLEASE RETURN PAPER APPLICATIONS TO: PACIFIC RIM CHRISTIAN UNIVERSITY ADMISSIONS OFFICE P.O. BOX 30147 HONOLULU, HI 96820 -- OR -EMAIL DIRECTLY TO [email protected] APPLICATION FOR ADMISSION I hereby apply for admission to Pacific Rim Christian University and certify that to the best of my knowledge the information given in this form is true. I understand that I am submitting confidential forms to persons named for reference on this application, and that these forms are to be returned by them directly to Pacific Rim Christian University Admissions Officer. I waive my right to see the completed references; I understand that my file may be made available to any appropriate faculty member or administration officer of Pacific Rim Christian University. Signature ______________________________________________________________ Date ______________________________ PACRIM.EDU | 808.853.1040 | [email protected]
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