Register for EQUIP® Leadership Certification

For help with this form or to speak with an AIM recruiter, please call 877-496-8342.

Please complete all portions of the application, using “n/a” for fields which do not apply. This registration is for the EQUIP® Leadership Certification. Please use our application for admission to enroll in a degree-granting program.

Personal Data

Name: *

Enter your first and last name.

Former Name:

Please provide maiden name or other name under which transcript(s) will be requested.

Date of Birth: *

Country of Citizenship: *

Contact Information

Phone: *

Please enter your primary phone number using 555-555-5555 format.

Alt. Phone:

Optional. Enter alternate phone number in 555-555-5555 format.

Email:

Contact Preference:

Phone

Let us know how you prefer to be contacted.

Mailing Address: *

City: *

State or Province:

Country: *

Zip/Postal Code: *

Course Selection

Select the course(s) you plan to complete. All three courses are required for certification.

Courses: *

Leadership I

Leadership II

Leadership III

Course Type: *

Certificate only ($149 per course)

College credit ($348 per course)

Please indicate whether you intend to take courses for certification or college credit.

Institutional Reporting Data

The information collected in this section is for reporting and statistical purposes. Your responses have no bearing on your admission to Ohio Christian University.

How did you hear about OCU?:

Ethnic Origin:

Gender:

Male

Female

Marital Status:

Church Name:

Denomination: