Home Education Application

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Home Education Application

* Indicates required field

Student's First Name *

Student's Last Name *

Student's Middle Name *

Student's Sex *

Male Female

Student's Nickname *

Social Security *

Student's Date of Birth *

Parent Name(s) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Does your student also live at the address above? *

Yes No

Parent Primary Phone *

Parent Email *

If you answered no above, please provide the address of the student's residence? *

Parent Alternate Phone *

May we contact you via email and texting? *

Yes No

Do you receive your email on your phone? *

Yes No

Student's Phone (if applicable) *

Student's Email (if applicable) *

Is your student a U.S. citizen? *

Yes No

Student Language *

English Spanish Other

Student Ethnic Heritage *

White/Non-Hispanic Asian Black/African American American Indian/Alaskan Native Native Hawaiian/Pacific Islander Hispanic Prefer not to answer

Church Information

Church you attend *

Are you a member? *

Yes No

Pastor's Name *

Denomination *

Is your student also a member of this church? *

Yes No

Church Website or Email *

Phone Number *

Church Address

Address *

Line 1

Line 2

City

State

Zip Code

Country

Enrollment

Which course interests you? (include course name, code, and semester) *

Education

Which education level most closely resembles the student's current placement? *

K-4 (Pre-kindergarten) K-5 (Kindergarten) Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Name and Contact of the student's Academic Records Administrator: *

Is your student a High School Graduate *

Yes No

If no, please note that you cannot receive a degree or certificate from Brookes Bible College until you have a diploma or GED

If yes, *

Traditional High-school Equivalency Test Homeschool

Graduation date or expected graduation date *

Month/Year

Background (Confidential)

If you answer YES to any of the following, please explain in the text box to the right.

Has your student been denied admission to an educational institution? *

Yes No

Has your student ever been placed on probation, suspension or dismissal at another educational institution? *

Yes No

Is your student now, or has he/she ever been involved in any substance abuse (drugs, alcohol, tobacco)? *

Yes No

Does your student have any record of juvenile arrest or conviction (excluding traffic violations)? *

Yes No

If yes, please explain. *

Influence

How did you hear about Brookes Bible College *

Billboard Website Radio Advertisement College Fair Sign Out Front Current Student/Alumni Pastor/Church Leader BBC Faculty/Staff Member Friend or relative (non BBC student/alumni) Conference Historical Faith Society (HFS) Other

If other, please specify: *

What factors influenced you to apply to Brookes Bible College? (check all that apply)? *

Current Students Alumni Church Leader Parent Degrees or Courses Available Price Location Doctrine Advertisement

Check all that apply

If more than one influence, what was the greatest? *

Emergency Contact

Name *

First

Last

Phone Number *

Email *

Relationship *

Statement of Faith

Does your student profess faith in Jesus Christ as personal Savior and Lord? *

Yes No

Is your student willing to submit to the student conduct policies while enrolled at BBC? *

Yes No

Have you and your student read the BBC statement of faith *

Yes No

Are you and your student in agreement with the BBC statement of faith *

Yes No

Are you and is your student open to instruction in areas of current disagreement with the BBC statement of faith? *

Yes No Not applicable (I am in agreement with the statement of faith)

While enrolled, are you willing to refrain from promoting views contrary to the BBC statement of faith? *

Yes No

If you answered no to any of the questions above, please explain *

In signing this application, I certify that all the information on this application is true and complete. I understand that falsifying any part of this application may result in cancellation of admission and/or registration. Finally, I promise, if accepted as a student, I will honorably adhere to the standards of the college.

Parent/Guardian’s E-Signature (Full Name) *

Date *

Submit