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CHRISTIAN PROFESSORS INTERNATIONAL ASSOCIATION
ADMISSION APPLICATION FORM – NO. CPIA/CG012670
(Non-denominational)
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Email: cpia2022@yahoo.com. / christianprofessorsinternation@gmail.com
Website: https://cpiass.org
ADMISSION FEE EQUIVALENT
Non-refundable Admission fee Ghc. 300 – (Ghana)
Non-refundable International admission fee USD50
- Name of Applicant: ___________________________________________________________
First name Middle Name Last Name/Surname
- Date of Birth: ____________________ Place of Birth______________________________
- Nationality: ___________________________ State/Province_________________________
- Hometown____________________________ House No. (if any) _____________________
- 5. Marital Status – Married: Single: Divorce Widowed
- Name of Spouse: ________________________________________________________
- Total number of Children: _____________________________________________________
- Secular Educational Qualification: _______________________________________________
- Theological Educational Qualification: ____________________________________________
- Area of Specialization_________________________________________________________
- Current place of work: (a) Church (b) Organization: Please Specify ___________________
_____________________________________________________________________________
- Full Membership: Current Academic Status: (i) Doctor (ii) Assistant Professor (iii) Associate Professor (iv) Full Professor
- Associate Membership: For Master’s Degree holders (MPhil. MA, MTh, MBA; M.Min; MSc M.Div. etc.) Specify Academic Qualification: _________________________________________
- Head office Address: ________________________________________________________
- Office Email Address: ________________________________________________________
- Office Phone No: _________________________Mobile No. _________________________
- Location: __________________________________________________________________
- How did you hear about CPIA? _________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
- State at least two reasons why you want to join CPIA
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Attach relevant up-to-date CVs
- Give two references: This section must be endorsed by your Referees
A: (i) Name …….……………………………………………………………………………………………………………………………..
(ii) Status……………………………………………………………………………………………….……………………………………….
(iii) How do you approve this applicant …………………………………………….……………………………………………
…………………………………………………………………………………………………………..………………………………………………
Signature …………………………………………… Address……………………..……………………………………………………..
Contacts:………………………………………………………………………………………………….Date………………………………..
B: (i) Name …….……………………………………………………………………………………………………………………………..
(ii) Status……………………………………………………………………………………………….……………………………………….
(iii) How do you approve this applicant …………………………………………….……………………………………………
…………………………………………………………………………………………………………..………………………………………………
. Signature ……………………………………………………. Address…………………………………………………………………..
Contacts…………………………………………………………………………………………………….Date……………………………….
__________________________ _______________
Signature of Applicant Date
FOR OFFICIAL USE ONLY
Membership Admission Number: CPIA/CG012670
Mode of Admission:
- Full Membership____________________________________________________
CVs Requirements Verification ____________________________________________
- Associate Membership______________________________________________
CVs Requirements Verification ____________________________________________
Remarks_____________________________________________________________________________________________________________________________________.
Date of Admission……………………………………………………………………………………………………………
Approved by: ___________________________________________________________
Signature _____________________________________________________________
Date ________________________________
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