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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