Distance Learning Application

Enrollment Information
Program Interest
Enrollment Type
Personal Information
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Phone Number

Country CodeArea CodePhone Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth
Citizenship
Gender
Marital Status
If Married, Name of Spouse
Spouse's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of Children
Home Church's Name
Pastor's Name
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How do you intend to finance your education?

For College Credit

If you have credits that you would like us to consider transferring, please list other schooling (College, Vocational, Business, etc.). A transcript will need to be submitted to us.
Name of School
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Attendance
Major
Degree or Diploma
Name of School
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Attendance
Major
Degree or Diploma
Briefly explain:
1. How you were saved/your salvation experience:
2. Any Christian service to date:
3. Your plans when you finish college:
4. Why you chose Dayspring Bible College & Seminary Distance Learning:
Statement of Intent
“I do hereby make application for the Dayspring Bible College & Seminary Distance Learning program, and agree to abide by all guidelines of the program.”
“I do hereby make application for the Dayspring Bible College & Seminary Distance Learning Program, and agree, if accepted, to cheerfully abide by all rules and regulations and cooperate fully in every respect in advancing the Christian testimony of the Dayspring Bible College & Seminary. I have read the Catalog, including the Statement of Faith, and am in full agreement with its policies, procedures, and other information contained therein.”
Student Signature
*Entering your name in the field above qualifies as your electronic signature.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Enrollment Information

Personal Information

For College Credit

Briefly explain:

Statement of Intent