This application is not for student enrollment, it is
only to be used upon personal inviataion by Benjamin Bhattu.

 

First Name
Middle Name
Last Name
Street Address
Apt.#
City
State
Zip code (Postal code)
Country
Social Security #
Telephone (home)
Telephone (cell))
E-mail Adress
Gender
Male Female
Place of Birth
(City, State, Nation)
Citizenship
United States Other
Date of Birth
(mm/dd/yy) Age
Marital Status
Single Married Re-Married
Separated Divorced Widowed
 
EDUCATION INFORMATION
College/ Unversity
Dates
To/From
Field of Study
Degree Earned or
Hours Completed
CREDIT CARD INFORMATION
In order to process your application for review/enrollment, a non-refundable
application fee of $50.00 USD is required and an Admissions Counselor will
contact you after reviewing your submission.
*First Name
*Last Name
*Type of card
Visa Master Discover
*First Name
*3 Digit
(on the back of card)
*Expiration Date
Month Year

I have read this on-line presentation of Rhema University and agree to abide by the standards
as set forth. I have told the truth to the best of my ability on this application. I
further acknowledge that no other representations have been made to me in
writing or orally other than what is stated in this on-line presentation. I
understand that all information given in this application is subject to verification
and will be confidential.

                             Place your name here as your Signature Date