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 *

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) *

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

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

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