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*
Present Address*

Street Address

Street Address Line 2

CityState

Zip Code
International Address- Outside the US
if you live outside the United State
Permanent Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Person to contact in case of emergency:*
Parent/Guardian
Relationship*
ex. Father, Mother, etc.
Phone Number*
Please enter a valid phone number.
Address of person to contact in case of emergency*
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
Proposed start date(Month,Year):*
Fees Information:

You must give details of who will be paying your fees.
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.
List Educational Experiences*
Tell us more about your experiences
Phone Number*
Please enter a valid phone number.
Education Qualifications:
Have you previously studied in the US?*

YesNo
Employment:

Please give details of curent and previous employers,together with dates.
List Current Employment*
Who do you currently work for.
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*
Please tell us where you heard about the school
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.
Pastors Name

First NameLast Name
Name of your current Church
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMail
example@example.com
Church Telephone Number
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
Signature*

Powered by Jotform SignClear

Payment Amount- Registration Fee- $80.00 USD- Non-Refundable*

USDDescription

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Afterpay

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
Date*

daymonthyear
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