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Enrollment Application
Please
fill out completely. *required
field
1.
Social Security#*
(ex: 555-55-5555)
2.
Legal Name
Last*
First*
MI
3.
Any other Legal Name?
Former
Last
First
MI
4.
Permanent Address*
City*
State*
(abbrev)
Zip*
Country*
5.
Home Phone*
(ex:
555-555-0000)
Work
Phone
Other Phone
6.
Personal Email Address*
7.
Date of Birth* Date
(mo/day/yr)
8.
Gender:
9.
Ethnic Background:
(optional)
If Other, please specify:
10.
Marital Status: (optional)
11.*
Are you now attending or have you ever attended CUBM?
12.*
Have you previously applied for admission to CUBM?
13.*
Please indicate the year you are applying for: 20
Please
indicate status for which you are applying:
14.
Employment: Name of employer:
Position:
Work
Hours:
15.
Church Membership:
If
Other, please specify:
Year
of ordination (if applicable):
16.
Describe ministerial responsibilities:
17.
Name of High School:
Graduation
Date:
Official
high school transcript required. See
application instructions
18.
If you did not graduate from high school, have you received
a State Equivalency Diploma?
Yes
No
If
yes, Official GED Transcript required. See
application instructions
19.
Please list all colleges and Bible Colleges that you are
attending or have attended.
List the most recent
college first and give ending dates for each college:
Official college transcripts
required. See
application instructions
College
1
From:
To:
City
State (abbrev)
College
2
From:
To:
City
State (abbrev)
College
3
From:
To:
City
State (abbrev)
20.*
Why do you want to study at CUBM:
21.*
What are your goals after graduation?
22.*
Have you have ever been dismissed from a college or university?
23.*
Have you ever served in the Armed Forces of the United States?
(Submit
a photocopy of your service record DD-214 and, if applicable,
your DD-295.)
See
application instructions
24.*
How did you hear about CUBM?
25.*
REFERENCES: List two people who can give witness to
your Christian character, academic preparation, and ministry
effectiveness.
Reference#1:
Name
Phone
Address
City
State
Zip
Reference#2:
Name
Phone
Address
City
State
Zip
Entrance Application Essay
Relating
to you as a person and fostering your academic success are
two of our primary objectives. To aid significantly
in meeting these relational and academic objectives, please
answer the following short answer essay questions.
•
Each short essay should contain 4- 6 sentences
•
The essays are not to be an autobiography; please thoughtfully
answer the questions below.
1.*
What is your motivation for specifically entering the Center
for Urban Biblical Ministry program?
2.*
Tell us something of your own life experience as it relates
to the overall curriculum content and your perspective on
how you might share this experience in a class interaction.
3.*
What are your strengths as they relate to your educational
goals?
Our
desire is to relate to you as a person and to have an early
indication of how we can best enhance your writing skills
for both the requirements of the Center for Urban Biblical
Ministry program as well as other life activities.
Sign and Submit Your Application
and Essay
Please
sign this form by typing your name and typing the date in
the spaces provided below. Your signature validates this
application and indicates that you have completed the information
and that the information is true.
Name:*
Date:*
(ex: 01/01/08)
Please
review your information to be sure all * required fields
are complete.
Incomplete applications may not be considered.
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