Christian Bible Institute Application Form.
(You can print this form; fill it out and mail to: CBI P. O. Box 3730 Harrisburg PA. 17105-3730.)
Date of Registration:....................................................
Name:....................................................................................................................................................................................................
Address:................................................................................................................................
City:..........................................State:........................................Zip:.............................................
Home Phone:...........................................Work Phone:........................................................
e-mail address:...............................................................................................................................
Occupation:.........................................................................................................................
Marital status (check one):
Single, Never married:................
Divorced:.....................................
Widowed:.....................................
Married:.......................................
In case of Emergency Call:
Name:..................................................................................................................................
Relationship:........................................................................................................................
Phone:...........................................................
Church Affiliation?.........................................................................................................................
Are you a member of the Church that you have listed?
Yes:.............
No:..............
If you answered "Yes" to the question above:
What ministries are you currently involved at the Church?
...........................................................................................................................................
Formal Education (Circle highest grade completed)
Grammar School........... 6 ....... 7 ........ 8 ........ 9 ........ 10 ......... 11 ......... 12 ...............
College ......... 1 ....... 2 ........ 3 ....... 4 ....... Master�s Degree ......... Doctorate .............
By signing this application form I am indicating that I am in full agreement with the purpose and mission statement of Christian Bible Institute and, if I am accepted as a student, I agree to abide by the policies set forth in the Christian Bible Institute Handbook.
CBI admits students of any race, color, nationality or ethnic origin to all rights, privileges, programs and activities generally made available to students at the institution.
Signature.....................................................................................................................................
Date.............................................................
