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Antioch Baptist Bible College, Institute,
Seminary, & School of Christian Counseling
 315 Grassdale Road
Cartersville, Ga. 30120

+ PRELIMINARY APPLICATION FORM +

(Please fill in the blanks and circle appropriate answers)
Name, Last:   First:  
Address 1:  
Address 2:  
City:   State:   Zip:  
Main Phone #: (    ):                    -                        -                      
Other Phone #: (    ):                    -                        -                    
Other Phone #: (    ):                    -                        -                    

(    )=(H)=Home, (W)=Work/Office, (Ch)=Church, (Cl)=Cell, (O)=Other
E-mail Address:  
Number of Hours desired:      ( 1 Sem. Hr. = 1 credit )
At $75.00 per Sem H, Tuition Due: = $
Titles and/or Course #(s):  
 
Additional info. may be added here:
 
 
 
Signature:  
 

Thank You For The Information You've Provided.

 


Other Personal Informationtiontion

(Please fill in the blanks and circle appropriate answers)
Date of Birth: Month:   Day:  Year:  
First Class Date: Month:  Day: Year:  

Have you experienced:
Baptism?:   Yes   No    Not Sure   (Please Circle One)
New Birth?:   Yes   No    Not Sure   (Please Circle One)
If so, by what means?:  
Name of Church you attend:  
 
Church Address:  
 
 
Educational Background. (Schools, Degrees, Dates) 
 
 
Please explain why you are considering Antioch College:  
 
 
 
 

FOR OFFICIAL USE ONLY

Date Received_______ Date Cataloged _______

Date Filed _______ Transcript Received_____