CBC Application FormPlease enable JavaScript in your browser to complete this form.Date of ApplicationMM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Full Legal Name *FirstMiddleLastName Variations Used (“Bill” for “William,” E.G.)TitleMr.Mrs.MissDr.Rev.OtherIf "Other", Please SpecifyEmail *EmailConfirm EmailPhone *Sex *MFDate of Birth *City, State and Country of Birth *Church MembershipResidential Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address (if different then residential address)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency ContactName *FirstLastRelationship to applicantAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *CitizenshipAre You a U.S. Citizen? *YesNoFor Non-U.S. Citizens OnlyNation of Citizenship- Please Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsRace / Origin- Please Select -American Indian or Native AlaskanAsian or Pacific IslanderAfrican AmericanHispanicWhiteNative LanguageCity and Country of BirthWhat is the status of your VISA?- Please select -I currently hold oneI am applying for oneWhat type of VISA?- Please select -F2J1J2NoneOtherIf Other, please specifyI-94 Expiration DateDateTimeIf you are a permanent immigrant, enter the alien registration number shown on your I-551 formWhich institution issued your last I-20?Please attach a photo of your Alien Registration card Click or drag a file to this area to upload. ReligionAre you a veteran of the U.S. Military?- Please Select -YesNoEnrollment DetailsAre you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *YesNoIf yes, please explainHave you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *YesNoIf yes, please explainSection DividerHigh School InformationHigh School (If homeschooled, simply write “Homeschooled”)Expected Graduation DateHigh School Address (if applicable)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHigh School PhoneAdditional Applicant InformationPastor's Name *FirstLastPastor's AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePastor's PhonePastor's Email *EmailConfirm EmailExtracurricular ActivitiesList your organizations, position, description of the activity, and hours per week of involvement.Notable Talents, Awards or Skills AchievedList each, a description, the level, and number of years of involvement.Service in Your CommunityList the type of work, your role, and hours per week of involvement.EmploymentList the job, your title, description, hours per week, and dates of employment.Attach an additional Word, PDF or text document if necessary Click or drag files to this area to upload. You can upload up to 4 files. Parent InformationThe information requested below is required for applicants aged 15-25. If you are in this age range, and feel that the information should not be required, please contact us at admissions@christendombiblecollege.org describing the reason for the exception.Father or Legal Guardian’s NameFirstLastFather or Legal Guardian’s PhoneMother or Legal Guardian’s NameFirstLastMother or Legal Guardian’s PhoneLegal Guardian's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFather or Legal Guardian OccupationFather or Legal Guardian Education- Please select -High School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreeMother or Legal Guardian OccupationMother or Legal Guardian Education- Please select -High School or LessTrade or Vocational SchoolSome CollegeUndergraduate College DegreeGraduate DegreePlease indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income.- Please select -$20,000-$39,999$40,000-$59,999$60,000-$79,999$80,000 or moreFees & AgreementsApplication FeePrice: $ 50.00Credit Card *CardName on CardAgreementI have read and agreed to the admissions policy found here: https://christendombiblecollege.org/policy/ By submitting this application, I intend to legally bind myself to the truth of the answers provided, to the best of my knowledge, and understand that any decision by CBC in reliance on the truth of these answers may be revoked upon discovery of the fraud or misinformation. I also agree to the release of any information required by any third party to CBC in its process of verifying the responses provided on this application, and waive any claim I may have against the third party for the release of the information related to the responses given in this application. Specifically, I agree to the release of any transcripts and test scores to this institution, including any PEERS, SAT, Achievement Test, and ACT Score Reports. By checking the box and signing below, I further certify that the information on this application is complete and accurate and that I have reviewed the same for errors. I understand that making false statements on my application is grounds for immediate dismissal, or lesser or greater discipline, and agree to the return of any property, grants or awards I may have received from this institution or any of its affiliates. If admitted, I agree to abide by the policies of the Institutions, included conduct and ethics policies, and in all matters of personal deportment, agree to abide by the personal ethical standards historically consistent with excellent Christian character, and scholarship. I understand and agree that the application fee submitted herewith 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.Yes, you may use my photograph on social media.Signature & Date *Clear SignatureSignatureSignature Date *Date signedSubmit