Print This form Name Social Security Number Last Four Digits XXX-XX- Permanent Address Present Mailing Address Email address Emergency Contact What Program are you applying For? Country of Citizenship If not a U.S. citizen, what is your visa type? What is your first language? If English is not your first language By checking this box and entering my name below, I certify that I have given full and complete information in this application and have listed each college and/or seminary I have attended. If admitted, I agree to abide by the standards of conduct as outlined in the current Richard Daniel Henton University Statement of Faith. I approve this as my electronic signature. Signature Date Richard Daniel Henton School of Ministry admits students of any race, color, sex, or national or ethnic origin to all the rights, privileges, and activities generally accorded or make available to all its students. In accordance with Title VI of the Civil Rights Acts of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973, RDH School of Ministry does not discriminate on the basis of race, color, sex, disability, age, or national or ethnic origin in the administration of its educational policies, admission policies, employment policies, scholarship programs, and athletic and other school-administered programs. Inquiries concerning compliance with these laws and the regulations thereunder should be directed to the Dean. This form and a nonrefundable registration fee should be returned to: Office of Admission, Richard Daniel University 2750 West Columbus Ave, Chicago, Illinois 60652.
