Life Pacific College
 
 
   
 
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Student Name:
   
Ministry Ally Church List:
Other:
 
Primary Ministry:
 
Church Address
Street: City: Zip:
 
Church Phone Number:
Senior Pastor's Name:
 
Primary Ministry Overseer
Name: Position:
 
Please fill out all the above information to the best of your ability (for example: If you don't know your church's address or you do not yet have a primary ministry, just let us know what church you are currently attending).