College Membership Application Form

Application Form Langham Literature Book Programmes

General Information

Reference Number

Institution Name:

Abbreviation:

Year Founded:

Physical Address:

City:

State / Province:

Area / Postal Code:

Country:

Institution Website:

Institution E-mail:

Telephone Number:

Fax Number:

Contact Person:

Contact Person E-mail:

Contact Person Position:

Principal:

Principal E-mail:

Academic Dean:

Academic Dean E-mail:

Librarian:

Librarian E-mail:

Administrator:

Administrator E-mail:

Academic Information:

Level of Programmes Offered

Certificate Diploma Bachelors Degree (BTh) Post-Graduate Degree

Programmes Accredited by:

Denominational Affiliation (if any):

Affiliate University or Institution (if applicable):

Current no. Lecturing Staff - Full-time:

Current no. Lecturing Staff - Part-time:

Current no. Students - Full-time:

Current no. Students - Part-time:

Primary Language of Instruction:

Other Language(s) of Instruction:

Academic Year:

Start month:

End month:

Date of Graduation Ceremony:

No. of Graduates:

Size of Library (no. of books):

No. of Computers:

With CD drive:

With Internet:

Internet connection

Broadband Dial-up

Delivery & Shipping Information:

State any restrictions or special requirements for book deliveries:

Delivery Address (if different from physical address);

Form Completed by;

Full name:

Position:

Signature:

Date;