ST TIKHON S ORTHODOX THEOLOGICAL SEMINARY APPLICATION FOR ADMISSION P.O. BOX 130 South Canaan, PA 18459-0130 Voice: 570-561-1818 E-mail: admissions@stots.edu FORM A (rev. 12/15) Name of Applicant: Date of Birth: Address: Phone: Email: Please attach photo here Social Security or Passport Number: Program of Study for which you are applying: Master of Divinity Special (Matriculated) Other (Non-Matriculated) ADMINISTRATIVE USE ONLY In order to be considered a candidate for admission, the applicant must submit to the Admissions Committee a completed and signed Application Form (Form A), together with the following documents and information: A recent photograph (passport size or similar) A certified copy of the Record of Baptism and/or Chrismation A completed Health Information Form (Form C) and Immunization Record (Form D) If you are currently in your last semester of college, please send a current transcript at the time of application, and a final transcript upon graduation, indicating grades for the final semester and conferral of your academic degree International students: please submit your latest TOEFL score(s) and Affidavit of Support (USCIS Form I-134; download at http://www.uscis.gov/files/form/i-134.pdf. If you are an international student seeking to transfer, please submit the International Student Transfer Form Applicants for the Certificate in Priestly Formation must submit their High School transcript (Form B), as well as the results of the SAT or the ACT A letter of recommendation from your Bishop, to be sent directly to the Seminary A letter of recommendation from each of your parish priests from the past five years, to be sent directly to the Seminary A brief biographical essay (1-2 pp.), reflecting on your professional background and interests, as well as your reasons for application to the Seminary; the biographical essay must be presented in typed form, on standard 8½ x 11 paper, dated and signed in ink Two additional letters of reference from individuals who can knowledgeably discuss your personal background, academic, and/or vocational qualifications, to be sent directly to the Seminary; these must be from persons other than relatives A non-refundable $55.00 Application Fee The personal and academic information supplied by the applicant forms an essential part of the Application for Admission. Failure to make written disclosure of information solicited on the Application Form, or misrepresentation of information supplied, may result in denial of admission. If such omissions or misrepresentations come to light after admission to the Seminary, and are reasonably believed to cast doubt upon your suitability for Seminary study, you may be subject to dismissal from the Seminary. St Tikhon s Seminary provides its educational programs and services in compliance with applicable federal, state and local non-discrimination laws. It is the prerogative of the Seminary to determine which applicants will be admitted. The Seminary administration reserves the right to determine the conditions under which seminarians and other students may continue in the Seminary programs or be required to withdraw. Admission to the Seminary, or the successful fulfillment of Seminary program and course requirements, does not automatically constitute qualification, or a basis, for ordination to Holy Orders of the Orthodox Church. In accordance with Orthodox canon law and practice, the appropriate Diocesan authorities make all ordination decisions. Any existing canonical impediments to ordination, including those that may arise through marriage, should be discussed directly with your Diocesan Bishop.
I. PERSONAL INFORMATION (PLEASE TYPE OR PRINT CLEARLY) 1. Applicant s Full Legal Name: 2. Permanent Address: City State Zip 3. Current contact information: Mailing Address (if different from above) City State Zip Telephone, with area code: E-mail 4. Place and Date of Birth: City, Country Date: (year, month, day) Citizenship: Visa status (if not US citizen): 5. Baptism and Chrismation: Date of Baptism Where Baptized: Date of Chrismation Where Chrismated: 6. Father: Father s full name (indicate if deceased) Place and Date of Birth Religion: 7. Mother: Mother s full name: (indicate if deceased) Place and Date of Birth: Religion: 8. Siblings (use additional sheet of paper, if necessary): 2
II. MARITAL STATUS 9. Applicant: Single (never married) Single (widowed or divorced) * Married (first marriage) Married (not first marriage) * Please note: If you or your spouse have previously been married, or if at the time of application, you are widowed or divorced, please attach a separate sheet detailing the circumstances of any previous marriage, divorce, or death of spouse. Include date, location, and civil or ecclesiastical authority under which each previous marriage, death or divorce were recognized. Full disclosure of your marital history and status are imperative for every Applicant. Under Orthodox canon law, your marital status, or that of your spouse, may present an ecclesiastical impediment to ordination. These should be discussed with your Diocesan Bishop prior to your application to the Seminary. 10. Applicant s spouse: First marriage Not first marriage* Previously widowed or divorced* 10a. Applicant s spouse: 11. Full name 12. Place and Date of Birth Place and Date of Marriage 12a. Name of Church or other location at which marriage was performed Check as applicable: 12b. Date of Marriage 12c. Civil ceremony 12d. Religious ceremony 12e. Spouse s religion 12f. If spouse is Orthodox, indicate Date and Place of Baptism: 12g. Date and Place of Chrismation 13. Number of children: Name Age Date of Birth Date of Baptism / Chrismation Name Age Date of Birth Date of Baptism/ Chrismation Name Age Date of Birth Date of Baptism/Chrismation Name Age Date of Birth Date of Baptism/ Chrismation III. ECCLESIASTICAL INFORMATION 14. Diocese 15. Name of Diocesan Bishop 16. Parish 17. Parish location (City, State) 18. Name of Parish Pastor 19. Telephone: 20. Address 21. City 22. State 23. Zip 3
IV. TONSURE AND ORDINATION TO HOLY ORDERS 24. Reader 24a. Month, Day, Year 24b. Location 24c. Bishop 25. Subdiaconate 26. Diaconate 25a. Month, Day, Year 25b. Location 25c. Bishop 26a. Month, Day, Year 26b. Location 26c. Bishop 27. Priesthood 27a. Month, Day, Year 27b. Location 27c. Bishop OTHER ECCLESIASTICAL OR CHURCH-RELATED ACTIVITIES: 28. Church School Director Teacher Student 29. Parish Choir Director Singer Other 30. Parish Council Officer (indicate which office) Other 31. Church Reader Tonsured Blessed 32. Church Server Blessed with orar Other Other 33. Other activities. Please describe. Use an additional sheet of paper if necessary. 34. Do you have relatives who are involved in church-related work (clergy, educators, choir directors)? Please indicate name, family relationship, and type of church-related work. V. EDUCATIONAL AND EMPLOYMENT BACKGROUND 35. List all Educational Institutions attended and degrees, diplomas, certificates received. Name Location Major Dates Attended From-To Degree Awarded 35a. Check if you are seeking credit transfer or Advanced standing. Explain in Item 47. Indicate institution, credit hours, and subject(s). 35b. Check if you are now, or have previously been, on academic and/or disciplinary probation. If so, please indicate circumstances In 47. 4
36. Please indicate language proficiencies: Language Where learned Level of Proficiency Reading Writing Conversation 37. Please list any special skills you may have, and other noteworthy achievements: 38. Work experience (Teaching, Industrial, Business, or other Professional Experience) - resume optional. Employer Location Duties Dates Paid Volunteer 39. Publications, theses, awards and creative work: 40. Have you ever served in the United States Armed Forces? If so, indicate branch of service, years served, service occupation, highest rank achieved. 41. List any community, civil, national, professional organizations and associations of which you currently are a member. 5
42. Are you a member of the Masons or a Masonic affiliate organization? 43. Is your spouse a member of a Masonic affiliate organization? Yes Yes No No 44. Financial Information. How do you plan to finance your Seminary education? Please check all that apply and explain if necessary: 44a. Personal savings 44b. Personal employment 44c. Spouse s employment 44d. Scholarships (list source) 44e. Loans (list source) 44f. Family Support 44g. Other (list) 44h. Do you have outstanding educational loans? (List) 45. List names and titles of those who will be supplying your references: 45a. 45b. 45c. 45d. 46. Biographical Statement of Professional Plans and Goals Write a brief biographical statement (1-2) pp.) indicating your reasons for application to the Seminary as well as reflecting on your professional background and interests. This statement is to be completed by all applicants and must be presented in typed form, on standard 8 1/2 x 11 paper, dated, and signed in ink. The quality of your statement may be of critical importance to the success of your application for admission, as well as for any award of financial aid. 47. Statement of Exceptional Circumstances On a separate sheet, indicate any personal information that may help the Admissions Committee interpret and evaluate your academic history and/or your academic credentials. Please type. PLEASE READ AND SIGN THE FOLLOWING: I understand that St. Tikhon s Seminary will create a student record in my name, and that admissions personnel will have access to this student record. I also understand that withholding information requested or giving false information may make me ineligible for admission to the Seminary and subject to dismissal. With this in mind, I certify that the above statements, to the best of my knowledge and belief, are correct and complete; and if admitted, I agree to abide by the published policies, rules and regulations of St. Tikhon s Orthodox Theological Seminary. I further understand that from the time I file my application with the Seminary, it is my responsibility to know all the rules, requirements, and exemptions for my intended program of study. In the event that I am not admitted into the program of study for which I hereby apply, I understand that I will not be entitled to any tuition refund for any courses taken while my application is under consideration. Signature Date DO NOT WRITE IN THIS BOX ADMINISTRATIVE USE ONLY 6