SEIBS Wife Application

Date*

Date

Full Name*

First NameMiddle NameLast NameSuffix

When do you want to begin classes*

AugustJanuary

Intended Start Date*

Year

What program do you intend to enter?*

Modified Full-Time Program (two year).Student Wife Program (two year Monday and Wednesday evening)

Please upload a recent photo of yourself and your family. Please limit the photo to 250k.

Upload Photo here

Date of Birth*

Date

Place of Birth*

Are you a United States citizen?*

YesNo

Social Security Number

What is your country of citizenship?

Are you in the country legally?

Is English your first language?*

YesNoOther

SPECIAL NOTE: Students who are not U.S. citizens must raise 100% of their own support to attend Southeast Institute of Biblical Studies. SEIBS is unable to provide any financial assistance to foreign students.

Passport Number*

Husband's name*

Husband's Birthdate*

Date

How long have you been married?*

If you have been divorced, please explain your situation in sufficient detail.

Please list the names and ages of your children.

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Format: (000) 000-0000.

Cell Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

confirm E-mail

Are you available for an in-person interview?*

YesNo

Are you available for a skype interview?*

YesNo

Current Congregation*

Congregation Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Congregation Phone Number*

Format: (000) 000-0000.

What are the are areas where you have served in the church?

Preacher's Name*

Preacher's Phone Number*

Format: (000) 000-0000.

Name of an Elder/Member acquainted with you*

Elder/Member Phone Number*

Format: (000) 000-0000.

When were you baptized? *

Marital History*

Married only onceDivorcedWidow

If you have been divorced and are remarried, please explain your situation in sufficient detail.

Have you been employed during the past 3 years?*

YesNo

Type of employment for the last 3 years

I have served in the U.S. Military

If so, were you honorably discharged?

yesNo

Are you qualified to receive V.A. educational benefits?

YesNo

Please provide the name, address, phone number, and email address of one church leader who has known you for the past three years or since you have become a Christian to serve as a reference for you.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Format: (000) 000-0000.

Email

example@example.com

Do you have a high school diploma or GED?*

YesNo

Have you had to withdraw from any school or college?*

YesNo

List high schools and any colleges you have attended as well as the years you attended *

List any previous college degrees earned

List any history of health problems (physical or emotional) and medications you take as treatment.

Have you been hospitalized for these medical problems (physical or emotional)?

Have you been through a formal rehabilitation program?*

YesNo

If yes, which program?

If you answered yes to this question, please provide the name, address, and phone number of the physician or professional counselor who worked with you in this area.

Do you have any physical handicap that might challenge you as a student?

YesNo

If yes, what type and when?

Have you ever been diagnosed with a learning disability or challenge?

YesNo

If yes, what type and when?

Do you use tobacco or alcohol?*

YesNo

Have you ever been convicted of any violation of the law (minor traffic violations excepted)?*

YesNo

What are your feelings about your husband attending the Southeast Institute of Biblical Studies and devoting his life to preaching? *

Conduct Agreement*

I will abide by all rules and regulations of SEIBS.I will maintain the highest moral, spiritual, and academic standards.I will, to the best of my ability, participate in all activities of SEIBS, the Karns congregation, and the classes designed for wives.I will do my best to complete all school work assigned.I will attend the services of the Karns church of Christ unless obligated elsewhere.

By entering your name here, you agree that your application has been faithfully completed.

E-Signature*

Click and hold to sign your name

Southeast Student Wife Application