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

+ PRELIMINARY APPLICATION FORM +
(P
ease fill in the blanks and circle appropriate answers)

 

Name,  First:  __________________  Last:  ____________________________

Address 1:  _____________________________________________________

Address 2:  _____________________________________________________

City:  _________________  State:  _________________  Zip:  _____________

E-mail Address:  _________________________________________________

Phone #: (* ): __________- __________- __________.

Other Phone #: (* ): __________- __________- __________.
(*)=(H)=Home, (W)=Work/Office, (Ch)=Church, (Cl)=Cell, (O)=Other (
Please ircle appropriate answers.)

 Number of Hours desired:  _______

 (1 Sem. Hr. = 1 Tuition Hr. or 1 Credit) @ $75.00 per hr. your tuition: = $ ____.___

 

Titles and/or Course #(s):  __________________________________________________

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Additional info. may be added here: ___________________________________________

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Signature: _________________________________

Thank You For The Information You've Provided.

Other Personal Information
 

Date of Birth: Month: ___________ Day:  ________ Year: _________

First Class Date: Month:_________ Day:_________ Year:  _________

Have you experienced "New Birth" ?: {Yes}  {No} {Not Sure}  (Please circle appropriate answers.)

If so, When: _______________  Where: _______________________________________

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Have you been baptized?: {Yes} {No} {Not Sure}  (Please circle appropriate answers.)

If so, by what means?: _____________________________________________________

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Name of Church you attend:   ________________________________________________

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Address: (If different, please explain. Include helpful info): __________________________

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Educational Background. (Schools, Degrees, Dates)":  _____________________________

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Please explain why you are considering Antioch College:   ___________________________

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FOR OFFICIAL USE ONLY

Date Received  _____________ Date Cataloged _____________



Date Filed _____________ Transcript Received _____________