Personal Details First Name * Middle Name Last Name * Date of Birth * DD/MM/YYYY Gender * Female Male Marital Status * Single Engaged Married Partner Widowed Divorced Separated Contact Details Phone * Country (###) ### #### Email * Home Address * This must be an Australian mailing address Address 1 Address 2 City State/Province Zip/Postal Code Country Next of Kin/Emergency Contact Full Name * Relationship * Phone * Country (###) ### #### Email * Background Are you an Australian Citizen or Permanent resident of Australia? * I am an Australian Citizen I am a Permanent resident of Australia Personal Health Do you have a disability? * Yes No Do you have any medical conditions? * Yes No If so, please describe Education Have you completed any of the following studies: Bachelors Degree Advanced Diploma Diploma Certificate IV Certificate III Certificate II Certificate I If so, what qualification/credentials have you received from higher education studies? Eg. Bachelor of Teaching (Primary School) Converge Enrolment I am applying for Enrolment into the BSSM Academic School Year: * 2025-26 I am applying to Converge for BSSM Year: * BSSM1 BSSM2 BSSM3 Have you received a BSSM acceptance letter? * Once received please email your Acceptance Letter to admissions@convergeaustralia.com *Note your application with Converge will not progress until you have been accepted to BSSM. Yes, I have an acceptance letter No, I have applied to BSSM and awaiting an invitation to interview Travelling Party Will you be travelling with family to BSSM? * Yes No If so, who will you be travelling with? Please include each individual person Eg. "My wife (first name) and two children Local Church What local Church are you attending in Australia? * *Or most recently attended Marketing and Publication Consent I consent to the inclusion of photos/videos of myself in Converge Australia, ACOM and BSSM publications, including promotional material * I Agree Release of Personal Information to Converge australia's partnership education providers I consent to the release of personal information between Australian College of Ministries (ACOM) and Bethel School of Supernatural Ministry (BSSM) as Converge Australia's partnership education providers * I agree Signature of Student Signature * By typing your name above you declare that you are that person, and all information provided is true and correct Date * DD/MM/YYYY Thank you for submitting your application to Converge Australia! We will be in contact with you within 7 days. APPLICATION FORM 2025 ALl personal details are privileged and confidential
