DUAL DEGREE PROGRAM
 Bachelors/Masters
 Masters/Doctorate

Anger Management Class
Zoom   250.00
Special DOC Price $150.00

Price $250.00

Shipping $10.00
​Please call us for more information or to register  

Trinity Christian Counseling Academy

OFFICE OF ADMISSIONS

66 Helen Street
New Martinsville, WV 26155

Email:drbutcher@tccmservices.org
Web: www.tccmservices.org

ENROLLMENT APPLICATION

Date: ___/___/___

​There is a one-time application and enrollment fee in the amount of $75.00 which is due and payable upon submission of this application. Please
make all checks or money orders payable to Trinity Christian Counseling Academy and return to the address above. Upon enrollment, a
Program Plan will be emailed to you and the selected course materials will be emailed or shipped to you via mail.

Last Name: ______________________________________ First Name: __________________________ MI: ________________
Marital Status: ______________________ DOB: _____/_____/_____ Age: ______ Sex: ________ SSN: ______-_____-________
Address: _______________________________________________________________ City: _____________________________
State: _________________ Country: _______________________________________ Postal/Zip Code: _____________________
Email: __________________________________________________________ Phone :(________) _________-______________
Please list all schools attended:
School & Location Dates Attended Diploma/Degree
From:_____/______  _________________________________________
To: _______/______
From:_____/________________________________________________
To: _______/______
From:_____/________________________________________________
To: _______/______
From:_____/______  _________________________________________
To: _______/______

1. On a separate sheet of paper please provide us with a sample of your writing by telling us your reasons for enrolling in this
Program. Please limit to 200 words or less.
2. Using the form on the next page, please request all prior educational institutions forward to Trinity Christian Counseling
Academy an official Transcript from their institution. Please be advised that Honorary Degrees will not be accepted towards
academic requirements.
3. By submitting this application for enrollment, you certify that all information presented herein is true and accurate.
4. By submitting this application for enrollment, you agree to the terms of tuition payment (Program Fees), materials and textbooks.
Further, the one-time application and enrollment fee in the amount of $75.00 is non-refundable.
I, ________________________________, hereby certify that all information attached and presented herein is true and accurate to the best of my
knowledge. I hereby make an application for enrollment in the above-noted Program indicated above, and will endeavor to do my best to adhere to
the standards of Trinity Christian Counseling Academy.

Signature: _______________________________ Date:____/____/____

Date Rec’d: ____/____/___                                   Fees Paid: Yes___ No___                                  Amount Paid  $______________

LEVEL OF STUDY
 Associate
 Bachelor
 Master
 Doctorate
 Ph.D.

Trinity Christian Counseling Academy

DISCIPLINE/CONCENTRATION

Christian counseling 

Theology
Anger Management
[] Grief Therapy