Re-enrollment Application

Thank you for your desire to re-enroll at the Word of Life Bible Institute. Please take the time to complete this form and submit it to us. Once it is reviewed for eligibility you will receive more information from the Admissions Office.

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Personal Information
 
 First Name:
  Middle Name:
 
 Last Name:
  Maiden Name:
 
 Date of Birth:
  Social Security Number:

Previous Attendance Information
 
 Year of last attendance?
 
 Term of last attendance?
 
 Campus of last attendance?
 
 Reason for leaving:

Re-Enrollment Information
 
 Re-enrollment year?
 
 Re-enrollment term?
 
 Campus:

Contact Information
 
 Country:
 
 Address 1:
  Address 2:
 
 City:
 
 State/Province:
 
 Postal Code:
 
 Home Phone:
  Mobile Phone:
 
 Email:

Citizenship Information
 
 Country of Birth:
 
 Country of Citizenship:
 
If you are not a US or Canadian citizen, are you a legal
permanent resident of the US or Canada?
Select one: Yes No Unsure

Marital Status
 
 Marital Status:
  First Name of Fiance / Spouse:
  Last Name of Fiance / Spouse:
  Names and Ages of Children:

Substance History
Have you ever used any of the following:
 
 Alcohol: No. Yes. The last time was:
 
 Tobacco: No. Yes. The last time was:
 
 Drugs: No. Yes. The last time was:

Doctrinal Agreement
 
 Have you read and are you in agreement with Word of Life's statement of faith: Yes No.
  If you answered "no", in what areas do you disagree?:
 
 Have you read and are you willing to submit to the standard of conduct while a student: Yes No.

Short Essay
 
 Please tell us what you have been doing since you attended and why you wish to re-enroll: