MBI REGISTRATION FORM
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Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Preferred Contact
Home
Mobile
Work
Date Of Birth
-
Month
-
Day
Year
Date
Current Age
Email
Fax Phone
Please enter a valid phone number.
Format: (000) 000-0000.
City/ State of Birth
Social Security Number
Racial/Ethnic Identification:(Required)
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
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Church you currently attend
Church Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type a question
Minister
Reverend
Pastor
Dr.
Ms.
Mr.
Mrs.
Church Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a born-again believer?
*
Yes
No
Date of Baptism
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Month
-
Day
Year
Date
List any activities or ministries you participate in at church:
Check all that apply
Single
Married
Separated
Divorced
Widowed
If married and have children, please complete the following:
Name of Spouse
First Name
Last Name
Name of Children and Ages
Date of High School graduation or GED
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Month
-
Day
Year
Date
List any extracurricular activities, honors, or awards received:
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List any Colleges you’ve attended:
City, State, Dates Attended, Hours, and Degree
Have you ever been on probation or dismissed from any school or college?
Yes
No
“If yes, please explain.”
Educational Objective
Select the option that applies:
Two year Biblical Certificate Program
Three year Standard Bible Curriculum
To be qualified to enroll in a degree granting School of Biblical Theology
How did you first learn of Manna Bible Institute?
*
Who or what influenced your decision to apply to Manna Bible Institute?
*
What are your educational or ministry goals?
*
How will Manna Bible Institute help you meet those goals?
*
Personal Information
List any ministry experience or training you may have.
Have you been a user of tobacco, alcohol, or illegal drugs in the past three months?
Yes
No
“If yes, please explain.”
Have you visited Manna Bible Institute?
Yes
No
Do you have a Manna Bible Institute catalog?
Yes
No
(Required)
*
I certify that the above statements are correct and complete. I am earnestly seeking God’s will for my life, and sincerely interested in a Christian education that can prepare me for Christian service. I understand the institute has standards of moral conduct set forth in the school catalog and student handbook, that I must pledge to abide by while enrolled. I am also aware that Manna Bible Institute makes no guarantee that any state program will accept credit earned at the Institute and employment is not guaranteed.
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