If you have already taken COS classes at United, please do not complete this form. Contact the COS Coordinator at cos@united.edu and request the credentials necessary to continue with registration.

Personal Information

Entry Term

Salutation/Title

First/Given Name

Preferred First Name

Middle Name

Last Name

Suffix

Previous Names

PID#

The following information is optional and is used for reporting purposes only.

Are you Hispanic/Latino

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Birthdate	[ 9/23/2017 ]
Gender
Home Phone
Mobile Phone
Email
Country Of Citizenship
Cirizenship Status
Military Status

Address Information

Mailing Address

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Address Line 1
Address Line 2
Address Line 3
City
State/Province
Postal Code
Is the Permanent Address Same as Mailing Address?

Permanent Address

Country
Address Line 1
Address Line 2
Address Line 3
City
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Postal Code

Additional Information

Person to contact in case of emergency
Emergency Contact Phone
Relation to you
Is English your first language
Is it OK to send text messages
What is the best time to contact you?
Denomination
Conference
District

Licensing School and Date
Conference Status
Educational Experiences
Food Allergy/Dietary Restrictions?
Credit from other COS Institution

By pressing Submit I give permission for release of my grades to the Division of Ordained Ministry, my Annual Conference and District Board.

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