Christian University and Seminary

Extension-Branch Application or The Church University program

Revised 10/09

Please type or print.  It is important to complete all information.

Professionalism, neatness and accurateness in completing your application package is important

Mail the completed application and related fees to CCU,  P.O. Box 586477, Orlando, FL 32858

For question questions, call 407-295-4869.           Fax: 1-866-706-8758

          branchextension@educateyouonline.com

                                                               Person Making the Request

Full Name
Title
Church or Ministry Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

                      Proposed Extension Name (e.g. CCU-Northside Bible College)

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

                                 Branch Extension President Data

Name
Title
Organization
Work Phone
FAX
E-mail
URL

                                 Please enter the package number 

Enter Package #:

                Please provide all traning and degree levels attained

1. 
2. 
3. 

4
5
6
7
8
BILLING
Purchase Order #
Account Name
SHIPPING TO SHIP YOUR MATERIALS
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

        Select the option that apply:

Extension Branch Package One (total expense $1135.00) to start your own school
Extension Branch Package Two (total expense $1635.00) to start your own school
Extension Branch Package Three (total expense $5135.00) to start your own school

       Choose this option if you're interested in the:


        Please enter any comments necessary


Author information goes here.
Copyright © 1999 Cornerstone Christian University. All rights reserved.
Revised: January 09, 2010