Gordon-Conwell Theological Seminary
Doctor of Ministry Program
BIOGRAPHICAL DATA FORM
Please complete this form thoughtfully and carefully!
ID #
SS #
NAME
GENDER
NICKNAME
BIRTHDATE
ADDRESS
BIRTHPLACE
CITIZENSHIP
CITY, STATE, ZIP
If you are not a US citizen, are you a
Resident Alien?
COUNTRY
If you are a US citizen, do you plan to
receive VA benefits?
HOME PHONE
ETHNIC GROUP
WORK PHONE
American Indian/Alaska Native Asian Black or African American White
Hispanic/Latino Pacific Islander Non-Resident Alien Undeclared
CELL PHONE
FAX
EMAIL
MINISTRY/EMPLOYER
HANDICAP
N-None B-Blind D-Deaf L-Learning Disability W-Wheelchair
MARITAL STATUS
S-Single
ADDRESS
M-Married
D-Divorced
W-Widowed
SPOUSE NAME
CITY, STATE, ZIP
BILLING ADDRESS
DENOMINATION
BILLING CITY, STATE,
ZIP
BILLING COUNTRY
DMIN TRACK
EXPECTED GRAD YR
STATISTICAL INFORMATION ON RACIA/ETHNIC GROUPS
The seminary is required to submit reports to the federal government and to the Association of Theological Schools containing statistical information on racial/ethnic
groups represented in our student body. This information will be used for statistical purposes only. You will never be personally identified by your racial/ethnic
group to any person or organization without your explicit, written permission.
American Indian or Native American – includes persons having origins in any of the original people of North America and who maintain cultural identification
through tribal affiliation or community recognition.
Asian or Pacific Islander – includes persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.
Icludes China, Japan, Korea, the Philippines.
Black, not of Hispanic origin – includes persons having origins in any of the black ethnic groups of Africa.
Hispanic – includes persons of Mexican, Puerto Rican, Cuban, Central or South American, or the Spanish culture or origin.
White, not of Hispanic origin – includes persons with origins in the original peoples of Europe, North Africa or the Middle East.