Student Application

Student Application
Name*

First NameMiddle NameLast Name
Sex*
Date of Birth*

MonthDayYear
US Citizen or Permanent Resident?*
Do you currently reside in the U.S.A?*
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dual enrollmentFull time – online academyPart time- online academy
Grade level*
Grade level*
LiteracyBibleMath
LiteracyHistory (First Semester)Science (Second Semester)BibleMath
BibleLanguage ArtsMathHistoryScience
BibleLanguage ArtsMathCivicsLife Science
BibleLanguage ArtsMath (Pre-Algebra)Physical ScienceWorld Geography
BibleEnglish 9 (10-month course)MathHistorySciencePhysical Education and HealthFinance and Economics
BibleEnglish 10 (10-month course)MathHistorySciencePhysical Education and HealthFinance and EconomicsTechnology
BibleEnglish 11 (10-month course)MathHistorySciencePhysical Education and HealthFinance and EconomicsTechnology
BibleEnglish 11 (10-month course)MathHistorySciencePhysical Education and HealthFinance and EconomicsTechnology
BibleEnglish 12 (10-month course)MathHistorySciencePhysical Education and HealthFinance and EconomicsTechnology
BibleEnglish 12 (10-month course)MathHistorySciencePhysical Education and HealthFinance and EconomicsTechnology
ArtAviationBibleBusiness/EconomicsChurch Ministries/ Worship StudiesCommunications/ WritingComputer Sciences/ Information StudiesCounseling/ Psychology/ SociologyCriminal JusticeEducationEnglishForeign LanguageGlobal Studies/ Ethics/ Western CultureGeography/ Government/ HistoryHealth/ NursingMathematicsParalegal StudiesScience
Interdisciplinary StudiesApologeticsBiblical StudiesBusinessCreative WritingCriminal JusticeEducationHistoryInformation SystemsMedical Office Assistant (AAS)Military HistoryParalegal StudiesPsychologyReligionSTEM: Mathematics (AS)
Application DevelopmentBusiness AdministrationDatabaseInformation AssuranceInternational BusinessProject ManagementWeb DevelopmentChristian MinistryHealth SciencesPre-School
Preferred starting date for course(s)*

MonthDayYear
Transcript

(for Full time and Dual enrollment students) Upload up to 5 files
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Report Card

(for Full time and Dual enrollment students) Upload up to 5 files
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Birth Certificate

(for Full time and Dual enrollment students) Upload up to 5 files
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Parent/Guardian Information form

(for Full time and Dual enrollment students) Upload up to 5 files
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Confidential Ministry Reference from the pastor of your congregation

(for Full time and Dual enrollment students) Upload up to 5 files
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Parent / Guardian Details
Parent / Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Application fee $50 per student

Non-refundable application fee $50 per student

$50.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Serving Institute Application
Should be Empty:

Student Application

Parent / Guardian Details