Application

Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Photo

Max. file size: 50 MB.

Prefer a 2" x 2" photo. (ex. passport photo)

Other names

List any other name(s) which may appear on transcripts or test score reports which may differ from the name listed above

Date of Birth

MM slash DD slash YYYY

Permanent Address(Required)

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

Residency

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

Ethnic Info

American Indian or Alaskan Native

African American, not of Hispanic Origin

Hispanic

Asian or Pacific Islander

White, not of Hispanic Origin

African

Please check all that apply.

Enrollment(Required)

Fall

Winter Intensive

Spring

Summer Intensive

When do you plan to begin your enrollment?

Start Year(Required)

Education History

Name of Institution

Years Attended

Type

Degree

Graduation Date

Major

GPA

*Type: indicate undergrad, graduate or post graduate education

References

Please list three or more persons acquainted with your academic and/or professional experience. Please submit three Recommendation Letters. Please have each reference listed. Recommendation letters can be e-mailed to info@pocsinstitute.org. Please have them indicate your name as the student in the letter.

References

Name

Title/Position

Phone

Affiliation

Affiliation: indicate their relationship to you: pastor, friend, coworker, relative, bishop/overseer, supervisor acquaintance, etc

Academic Honors

List significant academic honors or awards and honor society memberships.

Tutoring Experience

On a Separate Sheet of paper. (500-word minimum)

Personal Statement

Can be added here or attached below

Personal Statement Upload

Max. file size: 5 MB.

CAPTCHA