Online Application

Please fill out the following form to apply.

*First Name:
*Middle Name:
*Last Name:
Applying For:
Permanent Address: Number/Street:
State:
City:
Zip Code:
Present Address: Number/Street:
State:
City:
Zip Code:
Home Phone Number:
Cell Phone Number:
Email Address:
Date of Birth:

Are You A Citizen: Yes No
Place of Birth:
Gender: Male Female
Marital Status
*If ever divorced, separated, and/or remarried, explain here.
Married women list maiden name: Spouse’s name:
Do You Have Any Children: Names Of Children:
Father's Name:
(Indicate deceased, if not living)
Father's Present Address:
Mother's Name:
(Indicate deceased, if not living)
Mother's Present Address:
* Home Church:
* Church Address:
* Name Of Pastor:
Church Phone:
Pastor’s Home Phone:
Are You A Member: Yes No Do You Attend Church Regularly? Yes No
Is This An Independent Baptist Church? Yes No
When Were You Saved?
*Have you ever served in the Armed Forces? Yes No Service: Dates Served:
Type Of Discharge:
Do You Want Veteran's Benefits? Yes No
* Do You Have A Police Record? Yes No If So, Explain Here
In the past three years have you engaged in drinking alcoholic beverages? Yes No
If yes, please explain how often and when you were last engaged in this activity.
In the past three years have you engaged in smoking? Yes No
If yes, please explain how often and when you were last engaged in this activity.
In the past three years have you engaged in taking illegal drugs? Yes No
If yes, please explain how often and when you were last engaged in this activity.
In the past three years have you attended a movie? Yes No
If yes, please explain how often and when you were last engaged in this activity.
Have you ever sought psychiatric/psychological counsel? Yes No
If so, please explain when, any hospitalizations, any medications given and a brief description of the circumstances.
Classifications You Expect To Have:



Check the area(s) of your interest:






Is your high school work still in progress? Yes No If so, when will you graduate?
Are you a high school graduate? Yes No If so, when did you graduate?
List any colleges, universities, and Bible institutes you have attended. Please use the school’s full name:
A.

B.
Name and address of high school you are now attending or the high school from which you graduated:
* Were you ever expelled, dropped, or suspended by any school or college?
Yes No
If yes, state details including the school, time, and reason for such action.
* Have you taken the American College Testing (ACT) program examination or the Scholastic Aptitude Test (SAT)?
Yes No