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. *