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:
Phone #: (* ): - - .
Other Phone #: (* ): - - .
(*)=(H)=Home, (W)=Work/Office, (Ch)=Church, (Cl)=Cell, (O)=Other
E-mail Address:
Number of Hours desired:
@ $75.00 per hr tuition: = $ .
(1 Sem. Hr. = 1 credit) (Amount 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 "New Birth"? {Yes} {No} {Not Sure}
If so, When: Where:
Have you been baptized? {Yes} {No} {Not Sure}.
If so, by what means?
Name of Church you attend:
Address: (If different, Please explain. Include helpful info):
Educational Background. (Schools, Degrees, Dates)
Please explain why you are considering Antioch College
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FOR OFFICIAL USE ONLY
Date Received_______ Date Cataloged _______
Date Filed _______ Transcript Received_____
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