Enrollment Confirmation Form

Reservation Deposit Form

Congratulations on your acceptance at Elim Bible Institute and College! Your next step in the admission process is to complete this form securing your place as an incoming student.

If you have questions, please contact the Admissions Office at 585-582-8260 or admissions@elim.edu.

Please confirm which semester you plan to enroll for:*

Fall, 2024Spring, 2025Summer, 2025

Would you like to pay your Reservation Deposit?*

YesNo

Please note: The reservation deposit is non-refundable at all times. For more information, please see the Academic Catalog (available at www.elim.edu) or contact the Accounting Office at accounting@elim.edu.

Reservation Deposit

Reservation Deposit$150.00

Total $0.00

Credit or Debit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Signature*

Please verify that you are human*