Safe Haven Interdenominational Bible College and Training Institute Registration Form

Safe Haven Interdenominational Bible College and Training Institute Registration Form

2022-2023 Academic School Year
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) *

Area Code Phone Number
Phone Number (alternate)

Area Code Phone Number
Email *
example@example.com
School Site *

Altavista, VA Chapel Hill, NC New Jersey Raleigh, NC Sanford, NC Winston-Salem, NC Zebulon, NC Durham, NC
Emergency Contact *

First Name Last Name
Emergency Contact Number *

Area Code Phone Number
Do you have a High School Diploma? (Copy Required)

Yes No Currently Enrolled (Dance Ministry Students ONLY)
Proof of High School Diploma (Optional)

Browse Files

Cancel of
Desired Program *

A.A in Biblical Studies (Degree) A.A in Biblical Studies (Certificate) B.A in Biblical Studies (Degree) B.A in Biblical Studies (Certificate) M.A in Biblical Studies (Degree) M.A in Biblical Studies (Certificate) M.A in Leadership and Pastoral Studies (Degree) M.A in Leadership and Pastoral Studies (Certificate) M.A in Deliverance Ministry A.A in Maintenance Engineering A.A in Business and Hospitality (Includes 4 Certifications) B.A in Business and Hospitality (Includes 4 Certifications) A.A in Dance Ministry (Degree) A.A in Dance Ministry (Certificate) HVAC
Signature *

Clear
Date *

Month Day Year
Date

Payment *

USD Registration Fee + 1st Class Payment

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