Canyon Hills Bible College Enrollment Application

Contact Information * required

First Name *

Last Name *

Home Phone *

Work Phone

Mobile Phone

Email *

Street *

City *

State *

Postal Code *

* Notes

What is your date of birth? (MM/DD/YY) *

What is your age? *

Are you male or female? *

What languages do you speak? *

What is your ethnic origin? *

What is your marital status? - Single - Married - Divorced - Widowed *

Social Security number: *

Country of Citizenship: USA /___ *

Personal Survey: I plan to enroll in: 1 class, 2 or more. *

I will be pursuing a ministerial credential. Yes, No, Not sure *

My vocational goal is (if known) *

My current employment: *

How did you hear about Canyon Hills Bible College? *

What was the most important factor in you decision to apply to CHBC? *

Educational Background: High School diploma or equivalent is required to enter CHBC. High school you attended and year graduated? *

College attended and year graduated: *

Have you ever been dismissed and/or placed on academic probation Indicate Yes or No. If yes, explain *

What honors / awards have you received? *

Have you been convicted of a criminal or civil offence? Indicate Yes or No. If yes, please explain. *

Church presently attend, Denomination: *

I attend church more than: Once each week, Twice each month, Once each month, Less than once each month, Rarely *

I am involved in church in the following ways: *

Christian Background: Have you accepted Jesus Christ as you Lord and Savior. Yes or No? *

If yes, how long have you been a Christian? *

Write a short paragraph describing your personal relationship with Christ. *

Each applicant must have two reference from persons who are familiar with the applicant’s character. Please supply the information below for those to whom you will give your reference forms (No relatives, please!) *

Canyon Hills Bible College Enrollment Application

Contact Information * required

What is your date of birth? (MM/DD/YY) *

What is your age? *

Are you male or female? *

What languages do you speak? *

What is your ethnic origin? *

What is your marital status? - Single - Married - Divorced - Widowed *

Social Security number: *

Country of Citizenship: USA /___ *

Personal Survey: I plan to enroll in: 1 class, 2 or more. *

I will be pursuing a ministerial credential. Yes, No, Not sure *

My vocational goal is (if known) *

My current employment: *

How did you hear about Canyon Hills Bible College? *

What was the most important factor in you decision to apply to CHBC? *

Educational Background: High School diploma or equivalent is required to enter CHBC. High school you attended and year graduated? *

College attended and year graduated: *

Have you ever been dismissed and/or placed on academic probation Indicate Yes or No. If yes, explain *

What honors / awards have you received? *

Have you been convicted of a criminal or civil offence? Indicate Yes or No. If yes, please explain. *

Church presently attend, Denomination: *

I attend church more than: Once each week, Twice each month, Once each month, Less than once each month, Rarely *

I am involved in church in the following ways: *

Christian Background: Have you accepted Jesus Christ as you Lord and Savior. Yes or No? *

If yes, how long have you been a Christian? *

Write a short paragraph describing your personal relationship with Christ. *

Each applicant must have two reference from persons who are familiar with the applicant’s character. Please supply the information below for those to whom you will give your reference forms (No relatives, please!) *

Minister’s Reference: Name, Position, Church, Phone *

Educator's Reference: Name, Position, Church, Phone *

I hereby certify to the best of my knowledge that all responses on this application are true. Indicate yes if true. *

Enter your name and the date to sign this document. *