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

PRELIMINARY APPLICATION FOR:


Name, Last _________________First ___________________

Address 1 _________________________________________

Address 2 ________________________________________

City ________________ State ___________ Zip __________

Phone #(___) ___-___-____ Other Phone #(___) ___-___-____
(H)=Home, (W)=Work/Office, (Ch)=Church, (Cl)=Cell, (P)=Pager, (O)=Other)

E-mail Address (s)___________________________________

Signature ___________________________________

            
Number of Hours desired ___ X $75.00 tuition = $_____
(1 Sem. Hr. = 1 credit) (Amount Due)


Thank You

Additional info. may be added here._______________________

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Other Personal Information
Please fill in the blanks or Circle appropriate answers.

Date of Birth: Month__________ Day_________ Year ________

First Class Date: Month________ Day_________ Year ________

Have you experienced the "New Birth"? Yes / No / Don’t know.

If so, When?________________ Where?___________________

Have you been baptized? Yes / No / Don’t know.

If so, by what means? ________________________________________

Name of Church you attend. ____________________________________

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___________