Application

Information:

Given/First Name	Middle Name	Family/Last Name	Todays Date MMDDYR
Street Address	City	State	ZIP
Home Phone	ALT Phone	Email Address	Date of Birth MMDDYR
Social Security No	Program Degree Desired	Name and Place of Worship

Education:

High School or GED Name and Place		Dates attended1	Did you graduate?1
College Name and Address	Dates attended	Did you graduate	Degree and Major
College Name and Address3	Dates attended	Did you graduate	Degree and Major
Additional Education

Employment:

Present Employer	Job Title	Employer Phone	Supervisor Name
Employer Address		Employment Dates	Reason for Leaving

Military:

Military Service Branch

Dates of Service

Rank at Discharge

Type of Discharge

Details:

Optional Demo Marital Status	Religious Preference		Race (Optional)
Emergency Contact Name	Emergency Contact Address		Emergency Contact Phone

Activities:

Extracurricular Activities

Additional Information

Application Fee Payment Made?

To the best of my ability, I promise and certify that the information on this application is correct, any supplements, and any other supporting materials-is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be False.

I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I further promise that if I am admitted to The North Tennessee Bible Institute And Seminary that I will “study to show myself approved unto God:” and that I will not cheat or have someone else take any test for me. I further promise to pay my account when it is due, realizing that others are sacrificing their time and money to help me further my Christian education.

Application/Enrollment Fees

For Mailed Payments

The North Tennessee Bible Institute
ATTN: Admissions
P.O. Box 20039
Clarksville, TN 37042