ANTIOCH BAPTIST BIBLE COLLEGE
INSTITUTE AND SEMINARY
315 Grassdale Road
Cartersville, Ga. 30120

PRELIMINARY APPLICATION FOR:


 
Name, Last ____________________First _____________________

  Address 1 ______________________________________________

  Address 2 ______________________________________________

  City __________________   State _____________  Zip __________

  Phone #(__) ____-____-____    Other Phone #(___) ____-____-_____
 
                 "( )" =  (H)=Home, (W)=Work/Office, (Ch)=Church, (Cl)=Cell, (P)=Pager, (O)=Other)

  E-mail Address (s)________________________________________

  Number of Hours desired ______ X $75.00 per hr tuition = $_____._+__
  (1 Sem. Hr. = 1 credit) (Amount Due)
 

  Course #(s) Titles:________________________________________

  _____________________________________________________

  _____________________________________________________.


  Thank You

 

  Additional info. may be added here. ____________________________

  _____________________________________________________

  _____________________________________________________

  _____________________________________________________.


 

  Signature ______________________________________________

 

 

Other Personal Information
Please fill in the blanks or Circle appropriate answers.

  Date of Birth: Month__________ Day_________ Year ________

  First Class Date: Month________ Day_________ Year ________

  Have you experienced the "New Birth"? Yes / No / Donít know.

  If so, When?________________ Where?_______________________

  Have you been baptized? Yes / No / Donít know. <= (Please circle one.)

  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___________