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?

Contact Information

Address 1:
  Address 2:
Postal Code:
Home Phone:
  Mobile Phone:

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: