1. Last Name ___________________First Name __________________Middle _____________

2.   Street  Address ______________________________________________________________

 City______________________State________Country_____________Postal Code ________

3. Home phone __________________________ Office phone ___________________________

4. Date of Birth (mm/dd/yy)  ______ /______ /___  5. SSN/SIN _____-____-_____  Sex ______

6. Church membership:__________________________________________________________

7. Pastor's Name___________________________________Phone ______________________

8. Pastor's Address _____________________________________________________________

 City______________________State________Country_____________Postal Code ________

9. Sponsor's  Name___________________________________Phone ______________________

10. Sponsor's Address _____________________________________________________________

 City______________________State________Country_____________Postal Code ________

PART II:
 Why you want to participate in the Freedom Achiever's Program (may be completed by
sponsor if necessary)?
 ____________________________________________________________________________
 ____________________________________________________________________________
 ____________________________________________________________________________
 ____________________________________________________________________________

PART III:
Application Checklist:

 1.     ____ I have attached a written account of my salvation experience.
 2.     ____ I have enclosed  a current photograph of myself
 3.     ____ I have enclosed $75 (U.S.) for the cost of tuition.
 4.     ____ I (Sponsor) have include my recommendations of duties for the student to complete:
(The work may be done in the local church or area and it may include such things as serving as an usher, helping in the nursery, church office work, assisting in hospital or nursing home visits, bus safety monitor and many other practical areas of ministry.)

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
 

This application must be completed and signed before it will be processed.  If you have questions
about the application process, please call or email.

______________________________________________                                __________________
Signature of applicant                                                                            Date signed

______________________________________________                                 __________________
Signature of Sponsor                                                                              Date signed

______________________________________________                                 __________________
Signature of Parent (if applicant is  under age 18)                             Date signed

Help us serve you and future FBCS students better:

1.  How did you find out about Freedom Bible College  & Seminary? (If you were told about FBCS
from one of our students or alumni, please provide his or her name)?  _________________________
______________________________________________________________________________________________

2.  Why did you choose Freedom Bible College & Seminary?____________________________________
_______________________________________________________________________________________________

3.  Are you interested in becoming an FBCS Regional Representative?_________________________

4.  Suggestions?______________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________