Enter Today's Date:

-- mm/dd/yy

Personal Name and Birth date information:

First Name
Last Name
Date of Birth
Sex	Male Female

Please provide the following contact information:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Have You Graduated From High School?

Yes No

Name of High School you graduated from.

List other colleges, universities, etc you have attended.

What Church do you attend?

How long have you attended your church? (years please)

Church Information

Denomination
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Website Address

Senior Pastors Name

Name

When did you accept Jesus Christ as your savior?

Give a brief statement of your Christian Faith?

What is your attitude toward the Baptism of the Holy Spirit?

The New Testament very clearly and in specific detail gives the qualifications for those called to full-time ministry. 
Would you prayerfully read 1 Timothy 3:1-7, 1Cor. 9:19-27 and 2Cor. 6:3-10. 
This gives you an idea of the calling you are considering.

Why do you think God is directing you to CCBI?

Reference #1

Name
Age

First Reference Contact Information

Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Second Reference

Name
Age

Second Reference Contact Information

Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Can we contact your Senior Pastor for a reference?

Yes No

I hereby apply for admission to CCBI City Church Bible Institute and certify that to the best of my
knowledge the information in this form is true.  I have read the Doctrinal Statement and, if admitted,
will cooperate in observing the regulations and upholding the standards of CCBI.  I understand that
contact will be made with those considered as references on this application form.  Any information
given to CCBI by the references listed on this Application Form is for use of the Admissions Office. 
I hereby waive my right to see them or to be apprised of any information contained therein. I further
authorize that the information contained in my application and student file may be made available to
any faculty member or administrative officer of CCBI.

Is the information in this application correct, and do you agree with the above statement?

Yes No