<p> United Methodist Course of Study Wesley Theological Seminary- Buffalo, NY Extension School 247 Cayuga Road, Suite 70, Cheektowaga, NY 14225 (716) 998-2512 www.unyumc.org/ministries/course-of-study-extension-school-buffalo-ny</p><p>Registration Form for Course of Study 2016-17</p><p>Name______Date______Name as it should appear on nametag ______SSN______Address______City, State, Zip______Telephone______E-Mail______</p><p>Education: High School___ College Hours Completed____ Degree(s) Awarded______(Please list all Degrees earned) ______</p><p>Demographic Information (This information is required by the General Board) ___African American ___Native American ___Hispanic/Latino ___Asian ___European American ___Male ___Female Date of Birth_____/_____/______</p><p>Course Enrollment Information What year of Course of Study School will you be attending? ___Year 1 ___Year 2 ___Year 3 ___Year 4 Course Name & Number you are registering for______(Students must fill out a separate registration form for each course)</p><p>2015-16 Courses offered at Buffalo, NY Extension School Aug. 12-13 & Sept. 16-17, Oct. 21-22 & Nov. 11-12, 2016 Jan. 13-14 & Feb. 17-18, 2017 March 24-25 & May 5-6, 2017 2016 Registration Due: 6-7-15 Registration Due: 8-16-15 Registration Due: 11-15-15 Registration Due: 2-8-16 Year COS-123 Formation and COS-122 Theological Heritage I: COS-124 Transformative COS-121 Bible I: 1 Discipleship Introduction Leadership Introduction Year COS-224 Administration COS-221 Bible II: Torah & COS-223 Worship and COS-222 Theological 2 and Israel’s Sacraments Heritage II: Early Polity History Church Year COS-321 Bible III: Gospels COS-322 Theological Heritage III: COS-323 Preaching COS-324 Congregational 3 Medieval- Care Reformation Year COS-424 Ethics COS-422 Theological Heritage IV: COS-421 Bible IV: Prophets, COS-423 Mission 4 Wesleyan Psalms & Wisdom Literature Movement</p><p>Registration Fee Please enclose the non-refundable registration fee of $75 per course. Make checks payable to Upper NY Conference and write the course number in the memo line. Registrations do not take effect until the registration fee is received. A late fee of $25.00 will be charged for all registration forms not postmarked by the due date. Billing for remaining costs will follow receipt of registration.</p><p>Please mail to: Judith Toone UM Course of Study 247 Cayuga Road, Suite 70 Cheektowaga, NY 14225</p><p>Registration Forms Are Due 60 Days Prior to 1st Day of Class Church Status Conference______</p><p>Are you appointed to a church?______Full time____ Part time____</p><p>Name of Church______</p><p>Have you completed studies for license as a Local Pastor? ______</p><p>Emergency Contact Please list the name and phone number of the person you wish to have contacted in case of emergency. Name______Phone______Relationship______</p><p>Special Physical Conditions Please list below any special physical conditions we should be aware of: This would include, difficulty with stairs, diabetes, heart ailments, allergies, physical limitations or other needs so we can better plan meals and special events. ______</p><p>Housing </p><p>Students are responsible for arranging their own overnight accommodations. </p><p>Student Signature I give authorization for my records for Course of Study to be reported to the Division of Ordained Ministry and my Conference and/or District Board of Ordained Ministry.</p><p>Signature______Date______</p><p>District Superintendent Signature This Local Pastor is authorized by my District to attend Wesley Theological Seminary’s Buffalo, NY Course of Study Extension School in 2015-16.</p><p>Name______Telephone______</p><p>District______E-mail______</p><p>Signature______Date______</p><p>Conference Registrar Signature This Local Pastor is authorized by our Conference to attend Wesley Theological Seminary’s Buffalo, NY Course of Study Extension School in 2015-16.</p><p>Name______Telephone______E-mail______</p><p>Address______</p><p>Signature______Date______</p><p>Please indicate here the amount of financial support from your Conference for this student______</p><p>Each Registration Form Must Include All 3 of the Above Signatures </p>