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

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First/Given Name

Preferred First Name

Middle Name

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Previous Names

PID#

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

Are you Hispanic/Latino

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Birthdate	[ 2/26/2021 ]
Gender
Home Phone
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Cirizenship Status
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Address Information

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Address Line 2
Address Line 3
City
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Is the Permanent Address Same as Mailing Address?

Permanent Address

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City
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Additional Information

Person to contact in case of emergency
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Relation to you
Is English your first language
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What is the best time to contact you?
Denomination
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Licensing School and Date
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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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