Safe Haven Interdenominational Bible College and Training Institute
2025-2026 Registration Form
Name (as you would like it displayed on your degree)
*
Prefix
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (primary)
*
Format: (000) 000-0000.
Phone Number (alternate)
Format: (000) 000-0000.
Email
*
example@example.com
School Site
*
Altavista, VA
Chapel Hill, NC
Goldsboro, NC
Denver, CO
Online
Sanford, NC
Benson, NC
Zebulon, NC
Lumberton, NC
Durham, NC
Other
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Format: (000) 000-0000.
Do you have a High School Diploma? (Copy Required)
*
Yes
No
Proof of High School Diploma (Optional)
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Desired Program
*
A.A in Biblical Studies (Degree)
B.A in Biblical Studies (Degree)
M.A in Biblical Studies (Degree)
M.A in Leadership and Pastoral Studies (Degree)
M.A in Deliverance Ministry
A.A in Business and Hospitality (Includes 4 Certifications)
B.A in Business and Hospitality (Includes 4 Certifications)
A.A Security Administration
High School Diploma
B.A Security Administration
M.A Security Administration
Doctorate
Other
Signature
*
Date
*
/
Month
/
Day
Year
Date
Payment
*
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USD
Nonrefundable Registration Fee of $150
Payment Methods
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