Please complete every item on this form that applies to you, sign and date the application, and return it to the Office of Admissions along with a recent photo and $30 non-refundable fee payable to All Saints Bible College. Failure to complete every item on this form may delay processing.

I want to attend Memphis Campus Online Campus.
Citizenship: U.S. Citizen Resident Alien Other (specify):
U.S. Social Security Number:
First Name: Last Name: Middle/Maiden:
Current Mailing Address:
Number & Street: Apartment no.:
City: State: Zip: Country:
Home Phone:   E-mail address:
Date of Birth (mm/dd/yyyy): Gender: Male Female
Ethnicity:    other:
Educational Plans
For what term are you applying?   Year:
Are you seeking a certificate or degree?
If "Yes", please indicate which:
If "No", do you plan to take coursework for audit or credit?:
Secondary Educational Information
High School (name):   Location:
Graduation Date:   Date Received the GED: Issuing Agency:
Post-Secondary Educational Information (list schools that you have attended beyond high school)
Name:   Location: Dates Attended:  Major:
Certificate/Degree Earned:
Name:   Location: Dates Attended:  Major:
Certificate/Degree Earned:
Employment & Financial Information
Are you employed?   Name of Employer:
Location:   Phone:   Your Occupation/Title
How do you plan to finance your education at the Bible College? (Check all that apply):
Savings   Parents   Home Church   Part-time Work   Loan   Scholarship   G.I. Bill   Matching Funds
Religious Information (optional)
Your denomination or religious tradition:
The local church that you attend or serve: Location:   Pastor/Minister's Name:
How do you serve in your local church?
If you are a member of the Church of God in Christ, supply the following information:
Jurisdiction Bishop's name Women's Supervisor
Are you Licensed or Ordained? Date of Ordination:
Denomination/Church issuing above credentials:
To what form of Christian service do you want to devote your life?
Military History
Military status:  Branch of Service:
Dates of Military Service:   Type of discharge:
Marital Status
What is your marital status?
Health/Medical Status
Are you currently under any form of medical or psychiatric care?
If yes, please explain:
Emergency contact person:
Name:  Relation to You:  Address  Phone
Housing Plans
What housing will you use?
Reference Information
Pastor's Name   Address (number & street)
City   State  Zip   Country  Telephone

Other reference (not a relative) who has known you for at least three years:
Name   Address (number & street)
City   State  Zip   Country  Telephone
I certify that the information in this application and supporting documents are accurate and true. I further certify that giving false information or withholding information may make me ineligible for admission or continued enrollment at All Saints Bible College.
Applicant's Signature:    Date:

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