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    Pioneers Enrollment Form

    Thank you for your interest in joining the Pioneers team and our training path to that eventual goal. Please complete this Enrollment Form designed to be accomplished in one sitting and click-on the SUBMIT button below. Please note this is not an application, you are accepted into the Pioneers Program, this is just our way of gathering information.

    If you would send a Headshot to the "Admissions Team" by email, it would be great!

    If you are only making an inquiry, use the "Request Info" form on the website or send an email to "Admissions".

    The Pioneers Program admits learners of any race, sex, age, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to learners. This university does not discriminate on the basis of race, sex, age, color, national and ethnic origin in administration of its educational policies, admissions policies, and other university-administered programs.

    PERSONAL and CONTACT INFO

    (req.) = REQUIRED fields...

    First Name (req.)

    Middle Name/Initial (req.)

    Last Name (req.)

    Suffix

    Preferred Name (nickname, or other)

    Address (physical) (req.)


    ,

    Phone (mobile) (req.)

    Is it OK to TEXT you at this #?

    Email (personal) (req.)

    MATRICULATION INFO

    Planned Academic Term (req.)

    For Which Program Are You Applying? (req.)

    DEMOGRAPHIC INFO

    Date of Birth (req.)

    Gender (req.)

    Marital Status (req.)

    Spouse's Name (if applicable)

    CHURCH INFO

    Church Name (req.)

    Pastor (req.)

    You should be receiving an email response within 24-72 hours or less. If that does not happen, please check your Junk/Spam mail folder. If no response, reach out to us at "Admssions".

    How Did You Hear About AgathonU? (req.)

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