Official Liberty Hall Bible Institute Registration Form

Official Registration Form

Specifically for ALL Students
Mr/Mrs/Miss/Ms
Full Name*

First NameMiddle NameLast Name
Gender

malefemale
Birth Date

MonthDayYear
Nationality
Country of Birth
Mobile Number*
Telephone Number*
E-mail*
example@example.com
International Address- Outside the US
if you live outside the United State
Present Address

Street Address

Street Address Line 2

CityState

Zip Code
Person to contact in case of emergency:*
Parent/Guardian
Permanent Address

Street Address

Street Address Line 2

CityState

Zip Code
Address of person to contact in case of emergency*
Proposed start date(Month,Year):*
Please tell us where you heard about the school
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship*
ex. Father, Mother, etc.
Have you previously studied in the US?

YesNo
Course of Study Applied for:
Campus of Residence
Please select one
Name of Course:*
Select your course of choice. You Must complete the certificat courses before attaining any of the degree courses.
Mode of study:*

Full timeOnline Learning
Fees Information:

You must give details of who will be paying your fees.
List Educational Experiences
Tell us more about your experiences
Who is expected to pay your fees?

YourselfSponsor
Name and address to which invoice is to be sent(if different from above)
Education:

Please give details of all Schools/Colleges/Universities attended. If you are a GED graduate, please state those details as well.
Education Qualifications:
List Current Employment
Who do you currently work for.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employment:

Please give details of curent and previous employers,together with dates.
Statement In Support Of Application:

This section must be completed. You should state why you want to undertake this course, any relevant experience, skills and attributes, and your long terms goals.
What your inspiration for attending Bible school?
Reference:

All applicants must provide two references.
Name of referee 1*
Organization*
Relationship to you*
Name of referee 2
Organization
Relationship to you
Support Requirements:

Please complete this section if you have any learning support/mobillity requirements.
Do you have a disability, medical conditon or require learning support?*

YesNo
If yes,please name and give brief details:
Declarations:
Data Protection Act 1988

I agree to the University processing pesonal data contained in this form or other data which the University may obtain from other people. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any legitimate reason including communication with me following the completion of my studies.

In addition, I agree to the University processing personal data described as ''Sensitive Data'' within the meaning of the Data Protection Act 1988, such processing to be undertaken for any purposes as indicated in the declaration above.

If my employer/sponsor is supporting my studies by paying my fess/allowing me study time I agree to my employer/sponsor being informed of the progress of my application and of my studies if I am accepted onto the course.
EMail
example@example.com
Church Telephone Number
Format: (000) 000-0000.
Declaration

I certify that, to the best of my knowledge, the information I have provided is complete and true. The name placed on this registration form will be considered the name you wish to represent you throughout the school year and will be presented to you on your certificate and/or degree at the time of graduation.
Signature of Applicant*

First NameLast Name
Date*

daymonthyear
Pastors Name

First NameLast Name
Name of your current Church
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature*

REGISTRATION FEE- $80 *

USDDescription

Payment Methods

Credit Card

Google Pay

Cash App Pay

Upload Photos and Documents

Cancelof
By submitting and signing this document, I agree that photos and testimonials can be used for administrative and marketing purposes*

YesNo
Should be Empty:

Official Registration Form

Course of Study Applied for:

Fees Information:

Education:

Education Qualifications:

Employment:

Statement In Support Of Application:

Reference:

Support Requirements:

Declarations:

Payment Methods