Application Form 2019 (1st Year)

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Section 4: Recommendations
First Personal Recommendation (not a relative)
Full Name*
Email Address*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Second Personal Recommendation (not a relative)
Full Name*
Email Address*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pastoral Recommendation (not a relative)
Full Name*
Email Address*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Section 5: Payment
Finances
Will you be prepared to pay REVIVE tuition?*
Tuition is $2,495. (NOT included, a $35 non-refundable application fee is due upon application.) Will you be able to pay tuition?
- Yes
- No
If no, please explain:*
Payment Information
Please Note: Upon your acceptance to REVIVE, please fill out and electronically submit the Financial Responsibility Form on our web site.
REVIVE 1st Year Application Fee*
Price: $35.00
Credit Card Information*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Information
Full Name*
Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Agreement
I understand that any falsification of information on this application is grounds for dismissal at any time. I hereby certify that the information I have supplied herein is true.
Do you agree?*
- By checking this box you agree to the above statement (Agreement)
Phone
This field is for validation purposes and should be left unchanged.

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Section 1: Personal Information