Application

Personal
Name *
Name
Gender *
Birthdate *
Birthdate
Marital Status *
Current Address *
Current Address
Cell Phone Number *
Cell Phone Number
Ability to Receive Text Messages *
Church
Church Phone *
Church Phone
Financial
Do you see any reason why you would not have the required tuition fees by the required dates? *
Phone *
Phone
Activities
Current Education Status
Family Background
Father's Name
Father's Name
Father's Address
Father's Address
Phone
Phone
Mother's Name
Mother's Name
Mother's Address
Mother's Address
Phone
Phone
I live with
Statement of Agreement
Refunds
REFUNDS MAY BE GIVEN WHEN YOU ARE GRANTED AN APPROVED WITHDRAWAL FROM THE PROGRAM. TO GET PROPER APPROVAL, YOU MUST BE IN JOINT AGREEMENT WITH THE DIRECTOR. EXPULSION BECAUSE OF DISCIPLINARY PROBLEMS WILL NOT BE CONSIDERED GROUNDS FOR A REFUND. IN ORDER TO SECURE PROPER APPROVAL, BOTH YOU AND THE DIRECTOR MUST COMPLETE AN OFFICIAL WITHDRAWAL FORM AT THE TIME OF YOUR DEPARTURE FROM THE PROGRAM.
Background
I AUTHORIZE GATEWAY SCHOOL OF ACTS AND ITS AGENTS TO VERIFY ANY INFORMATION RELATED TO MY APPLICATION. I ALSO AUTHORIZE INDIVIDUALS, SCHOOLS, EMPLOYERS, AND LAW ENFORCEMENT OR GOVERNMENT OFFICIALS TO FREELY RELEASE ANY INFORMATION CONCERNING MY BACKGROUND, AND HEREBY RELEASE ANY AND ALL OF THEM FROM ANY LIABILITY FOR DOING SO. I UNDERSTAND THAT BY TYPING MY FULL NAME BELOW REPRESENTS MY AGREEMENT WITH AND MY KNOWLEDGE OF. I UNDERSTAND THAT FAILURE TO PROVIDE ACCURATE AND COMPLETE INFORMATION WILL RESULT IN DENIAL OF ADMISSION.
I UNDERSTAND THE REFUND POLICY STATED ABOVE AND THAT THE DLA STAFF RESERVES THE RIGHT TO DISCIPLINE OR, AS A FINAL ACTION, DISMISS ME FROM THE PROGRAM WITH NO FINANCIAL REIMBURSEMENT. I UNDERSTAND THAT REFUNDS MAY BE GIVEN IF I AM GRANTED AN APPROVED WITHDRAWAL FROM THE PROGRAM.
Signature of Agreement
Applicant *
Applicant
Date *
Date
Witness *
Witness
Date *
Date