ASIAN COLLEGE OF THEOLOGICAL STUDIES AND MISSION INC.
430 Barrangka Drive, Mandaluyong City Philippines
Mobile No. 09189480548
APPLICATION FORM
PERSONAL DATA
Name: RAUL G. MOLDEZ NCAE Result:________ Student No. :_________
Date of Birth: Apil 10 1972 Age: 42 Gender: Male Citizenship: Filipino
Place of Birth: Iligan City Contact No: 0935-837-6904
Civil Status: Married Name of Spouse (If Married): Gloria Moldez
Present Address: B15, L2 Silang-Del Pilar Sts
Regency Plain Subdivision
Iponan, Cagayan de Oro City
Fathers Name: Renato L. Moldez (Deceased)
Mothers Name: Crispina G. Moldez Occupation: Housekeeper
Parents/Guardian Address:Lungsodaan, Padre Burgos, Southern Leyte
Religion: United Church of Christ in the Philippines
Church Address: Iponan, Cagayan de Oro
Position in the Church: None
EDUCATIONAL BACKGROUND
Elementary: P. Burgos Central School Year Graduated: 1985
High School: St. James Aacedmy Year Graduated: 1989
College: Liceo de Cagayan Year Graduated: 1993
Course: Bachelor of Arts in English
Bible School Seminary: Mt Apo Alliance Bible College Year Graduated: 2014
Bachelor of Theology
Graduate School: University of Bohol Year Graduated: 2014
Master of Public Administration
CHARACTER REFERENCE
Name Address
1. Ptr Jeffrey Uriarte Balulang, CdO City 09069174903
2. Rev. Jonathan Pagalan Iponan UCCP, CdO City 09159850868
3. Ptr Miguel Ladao Balulang, CdO City 09284958091
COURSES (check only the course being enrolled)
( ) Diploma in Christian Education (2 yrs) ( ) Master of Ministry (2 yrs)
( ) Bachelor of Science in Theology (4 yrs) ( ) Master of Divinity (3yrs)
( ) Bachelor of Science in Social Work (4 yrs) ( x) Master of Pastoral Studies (2 yrs)
( ) Bachelor of Arts in Christian Education (4 yrs) ( ) Doctor in Pastoral Studies (2 yrs)
( ) Master of Arts in Christian Education (4 yrs) ( ) Doctor of Ministry (2 yrs)
( ) Master of Arts in Theology ( ) Doctor of Philosophy in Theology (3yrs)
Issued Date: December 6, 2014 Applied Date: _______________________
Applicant Signature: Raul G. Moldez Approved by: _______________________