Enrollment Application

Please fill out completely. *required field


1. Social Security#*  (ex: 555-55-5555)

2. Legal Name

    Last*    First* MI

3. Any other Legal Name?      Former

    Last    First MI

4. Permanent Address*
    State* (abbrev)       Zip*       Country*

5. Home Phone*  (ex: 555-555-0000)
    Work Phone   
    Other Phone    

6. Personal Email Address*

7. Date of Birth*  Date (mo/day/yr)

8. Gender:       

9. Ethnic Background: (optional)   

     If Other, please specify:   

10. Marital Status: (optional)     

11.* Are you now attending or have you ever attended CUBM?   

12.* Have you previously applied for admission to CUBM?   

13.* Please indicate the year you are applying for:   20

      Please indicate status for which you are applying:


14. Employment:    Name of employer:  

      Position:   Work Hours:  

15. Church Membership:    


      If Other, please specify:   

     Year of ordination (if applicable):    

16. Describe ministerial responsibilities:


17. Name of High School:   

      Graduation Date:   

     Official high school transcript required.  See application instructions

18. If you did not graduate from high school, have you received a State Equivalency Diploma?

      Yes        No    If yes, Official GED Transcript required. See application instructions

19. Please list all colleges and Bible Colleges that you are attending or have attended.
       List the most recent college first and give ending dates for each college:
      Official college transcripts required.  See application instructions

      College 1   

      From: To:

      City   State (abbrev)  

      College 2   

      From:   To:

      City   State (abbrev)  

      College 3   

      From:   To:

      City   State (abbrev)  

20.* Why do you want to study at CUBM:


21.* What are your goals after graduation?


22.* Have you have ever been dismissed from a college or university?       

23.* Have you ever served in the Armed Forces of the United States?      

      (Submit a photocopy of your service record DD-214 and, if applicable, your DD-295.)
See application instructions

24.* Have you ever been convicted of or plead guilty to a felony or misdemeanor (excluding traffic violations)?     Yes      No

25.* How did you hear about CUBM?


26.* REFERENCES:  List two people who can give witness to your Christian character, academic preparation, and ministry effectiveness.

Reference#1:    Name    Phone

     Address    City   

     State      Zip

Reference#2:    Name    Phone

     Address    City   

     State      Zip

Entrance Application Essay

Relating to you as a person and fostering your academic success are two of our primary objectives.  To aid significantly in meeting these relational and academic objectives, please answer the following short answer essay questions.

• Each short essay should contain 4- 6 sentences

• The essays are not to be an autobiography; please thoughtfully answer the questions below.


1.* What is your motivation for specifically entering the Center for Urban Biblical Ministry program?


2.* Tell us something of your own life experience as it relates to the overall curriculum content and your perspective on how you might share this experience in a class interaction.


3.* What are your strengths as they relate to your educational goals?

Our desire is to relate to you as a person and to have an early indication of how we can best enhance your writing skills for both the requirements of the Center for Urban Biblical Ministry program as well as other life activities.

Sign and Submit Your Application and Essay

Please sign this form by typing your name and typing the date in the spaces provided below. By typing my name here, I validate that all the information I have provided above in this application is complete and true.

Name:*      Date:* (ex: 01/01/08)

Please review your information to be sure all * required fields are complete.
Incomplete applications may not be considered.

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