APPLICATION FORM

APPLICATION FORM
Thank you for your interest in the Instituto Bíblico Centroamericano. Before completing this application, please read the Student Handbook thoroughly.

We encourage you to prayerfully consider if you are capable of fulfilling each one of the purposes and objectives of this organization in case you are accepted.
I wish to take the*

Medical Missionary CourseSpanish Learning CourseEnglish Learning Course
1. PERSONAL INFORMATION
Full name*
Gender*
Nationality*
Date of birth*

MonthDayYear
Address*
Passport number*
Email*
example@example.com
Mobile phone*

Area CodePhone Number
Home phone

Area CodePhone Number
Profession or occupation*
Marital status*
Are you involved in a relationship?*

YesNo
Number of children*
2. RESIDENCY

Only for students applying from outside of Honduras
Country where your passport was issued
Date of issue

MesDíaAño
Expiration date

MesDíaAño
3. DEPENDENTS

People who are financially dependent on you
3.1. Name as it appears on passport
3.1. Relationship
3.1. Date of birth

MesDíaAño
3.2. Name as it appears on passport
3.2. Relationship
3.2. Date of birth

MesDíaAño
3.3. Name as it appears on passport
3.3. Relationship
3.3. Date of birth

MesDíaAño
4. CHRISTIAN EXPERIENCE
Are you a baptized member of the Seventh-day Adventist Church?*

YesNo
If so, what is your baptismal date?

MesDíaAño
Name of the church you attend
Please describe your relationship with the Seventh-day Adventist Church. How do you feel you live in harmony with the message of the church, the 28 fundamental beliefs, and the church’s mission?*
Please describe your Christian experience, conversion, personal growth in Christ, and your personal relationship with God.*
Have you worked as a volunteer?*

YesNo
Have you participated in outreach?*

YesNo
If you answered Yes to either of these questions, please describe:
Are you ready to do your best in spite of the difficult jobs you are assigned to do?*

YesNo
What are your weaknesses?*
What are your hobbies?*
5. PURPOSE FOR STUDYING AT IBC
How did you find out about IBC?*

WebsiteFriendsChurchOther
What is your purpose for studying at IBC?*
Do you have any particular skills? Please mention them:
6. LANGUAGES
How do you consider your Spanish?*

FluentModeratePoor
How do you consider your English?*

FluentModeratePoor
What other languages do you speak?
7. FINANCES
I will pay the cost of the course described in the Student Handbook*

YesNo
8. PHYSICAL CONDITION AND CONTACT IN CASE OF EMERGENCY
Have you experienced any medical problems in the past, or are you currently being treated for heart problems, cancer, etc.?*

YesNo
Have you been or are you taking medication for mental problems, panic attacks, or a personality or eating disorder?*

YesNo
Have you been or are you being treated for substance abuse such as alcohol, illegal drugs, etc.?*

YesNo
Are you being treated for high blood pressure or diabetes?*

YesNo
Do you have a condition that requires immediate medical service?*

YesNo
If so, please describe:
Do you have any health condition that limits your activity?*

YesNo
Are you currently taking any medicine?*

YesNo
Do you have any learning problems such as dyslexia, attention deficit disorder, etc.?*

YesNo
If so, please describe:
Do you suffer from any allergies (food, environment, season, etc.)?*

YesNo
Describe:
Contact in case of emergency*
Telephone*

Código de áreaNúmero de teléfono
Address*
In case of an emergency, you authorize the Instituto Bíblico Centroamericano to do everything possible to receive the best medical treatment available or any medical procedure that is necessary to maintain your life, until your parents/guardians arrive (if you are under 21 years of age) or you are able to make a personal decision.
9. DOCUMENTS
The following documents must be attached to this application form to start the process:
Currículum Vitae*

Cancelof
Copy of passport or identity card*

Cancelof
If you are applying for a scholarship, please attach a financial proposal from you and/or your parents.

Cancelof
Three people must fill out the Reference form: Your pastor and two non-family members of your church.
10. PERSONAL COMMITMENT
I have answered all questions correctly. If I am accepted, I promise to comply with the principles and standards of IBC as have previously been described in the Student Handbook. I also agree that IBC may conduct interviews with other people to obtain references about me.
Signature*

Clear
Date*

MesDíaAño
Should be Empty:

APPLICATION FORM

1. PERSONAL INFORMATION

2. RESIDENCY

3. DEPENDENTS

4. CHRISTIAN EXPERIENCE

5. PURPOSE FOR STUDYING AT IBC

6. LANGUAGES

7. FINANCES

8. PHYSICAL CONDITION AND CONTACT IN CASE OF EMERGENCY

9. DOCUMENTS

10. PERSONAL COMMITMENT