EmailMe Form - CASCADIA NORTHWEST BIBLE COLLEGE

Name *

First Last

Email *

Social Security Number *

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Emergency Contact

Name

First Last

Relationship

Phone

### - ### - ####

Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Colleges that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Race / National Origin

Native Language

Religion

Gender

Male

Female

Are you a veteran of the U.S. Military?

Yes

No

Date of Birth

MM / DD / YYYY

This application is for enrollment as: *

Associate of Bibilical Studies

Bachelor of Biblical Studies

Honorary Degree

High School Information

High School Name *

Graduation Date *

MM / DD / YYYY

High School Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

High School Web Site

High School Phone

### - ### - ####

Extracurricular, Personal and Volunteer Activities

Talents and Awards:

List each, a description, the level, and number of years of involvement.

Extracurricular Activities:

List your organizations, position, description of the activity, and hours per week of involvement.

Employment:

List the job, your title, description, hours per week, and dates of employment.

Community Service Work:

List the type of work, your role, and hours per week of involvement.

Attach additional Word, Powerpoint, PDF or text document if necessary.

For Non-U.S. Citizens Only

City and Country of Birth

What is the status of your VISA?

What type of VISA?

If other:

I-94 Expiration Date

MM / DD / YYYY

If you are a permanent immigrant, enter the alien registration number shown on your I-551 form:

Which institution issued your last I-20?

Did you attend?

Yes

No

Please attach a photo of your Alien Registration card.

I understand that this application is for admission only for the term indicated. I agree that I am bound by the University’s regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports.

I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned.

If admitted, I agree to abide by the policies of the Board of Regents and the rules and regulations of the University. Should any information change prior to my entry into the University, I will notify the Office of Admissions.

I understand that the application fee I submit with this application is a non-refundable fee.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Events, activities, programs and facilities of the Univeristy are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age, Vietnam or disabled veteran status as provided by law and in accordance with the University’s respect for personal dignity.

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