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Application: Extension Center

Currently, Seminary Extension requires an actual signature before we can process your center application; therefore, we are unable to accept applications electronically at this time. A $35 fee is required with the completed application. Fill in all information on this application. Using the print option on your browser menu, print the completed form, sign at the arrow and mail to Seminary Extension, 901 Commerce St., Suite 500, Nashville, TN 37203-3631.

Sponsor
Mailing Address
City
State
Zip
Telephone
Email
Local Association
(if applicable)
Center Name
Proposed Director
Social Security #
Telephone
Director is
Director of Missions
Pastor
Other 
Proposed Treasurer
Proposed Registrar
  In applying for certification with Seminary Extension, we agree to abide by the policies and academic standards set by Seminary Extension.
Director's Signature  
Date  
 

Note: The center is not officially registered until it has been certified by Seminary Extension. Certification is for a five-year period.

Indicate on this form where you want the Seminary Extension materials sent:

1. Administrative materials and update materials are sent to Extension Center Director.

You may want these materials sent to the sponsor's address in care of the center director, or you may prefer the materials be sent to another address. Please indicate your preference:

Send materials to the center director at the sponsor's address.
Send materials to the center director at the address indicated below
Name
Address
City
State
Zip
 

2. Finance statements and invoices may be sent to the Center Director or to the Treasurer. Please indicate your preference:

Send financial material to the center director at sponsor's address.
Send financial materials to the center director at the above address.
Send financial materials to the Seminary Extension Treasurer at the sponsor's address.
Send financial materials to the Seminary Extension Treasurer at the address indicated below:
Name
Address
City
State
Zip
Other special mailing instructions
Complete and return this form to: Seminary Extension
901 Commerce St., Suite 500
Nashville, TN 37203-3631
 

FOR SEMINARY EXTENSION USE ONLY
Date Approved OM Sent
EC Director's Signature Promo Kit Sent
Dates of Certification Center Cert. Sent
Sponsor Type    



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