Fairwood Bible Institute
18
Fairwood Drive, Dublin, New Hampshire
03444-8320 603-563-8492 FAX
603-563-8138
Application
for Admission
Send
with $25 application fee and a photograph of yourself.
I. General Information
1. Legal Name__________________________________ Date of Birth__________________
Name I go by____________________________ Place of Birth_______________________
Social Security No.____________________ Driver's Lic. No._______________ State_____
2. Home address: ____________________________________________________________
City____________________________ State_______ Zip__________ Telephone___-___-____
3. Sex___ Race___ Height_______ Weight_______ Citizenship_____________________
4. Status: __single __engaged __married __widowed __separated __divorced
II.
Personal History
1.
Parent(s) or Guardian:
Name____________________________________________________________________
Address________________________________ State____ Zip________ Tel.___-___-_____
2. Parents are: __married __divorced __father deceased __mother deceased
Father's Name __________________________ Mother's Name_______________________
3.
Check Appropriate box:
[
]yes [ ]no
Are your parents opposed to your decision to attend Fairwood Bible
Institute?
[
]yes [ ]no
Have you any significant physical or learning impairment?
[
]yes [ ]no
Have you ever been treated for any nervous, mental, or emotional
disorder?
[
]yes [ ]no
Have you ever used illegal or dangerous drugs?
[
]yes [ ]no
Do you in any way use alcoholic beverages?
[
]yes [ ]no
Do you use tobacco in any form?
[
]yes [ ]no
Do you currently have financial obligations?
[
]yes [ ]no
Were you ever expelled, dropped, or suspended by any school or college?
[
]yes [ ]no
Are you or have you ever been under the supervision of a parole officer
or court?
[
]yes [ ]no
Have you ever been arrested for any reason other than a minor traffic
violation?
[
]yes [ ]no
Do you have any disagreement with the Doctrinal Position (page 7 in
handbook)?
If
any answer is yes, please give complete details on a separate sheet of paper.
4. Write a brief autobiography (1-2 pages) mentioning your conversion, baptism, high points of your Christian experience, family background and anything else that might have a bearing on your attending Fairwood Bible Institute. This could include your standard of conduct and personal convictions toward chastity, parental authority, inspiration of scripture, worldly entertainment, alcohol, drugs, etc. (Use a separate piece of paper.)
III.
Christian Experience
1.
Church Affiliation_____________________________________________________________
Address_______________________________ City_____________ State____
Zip________
Your Average Attendance: __twice
a week __weekly __monthly
__yearly
2.
Has there ever been a time in your life when you actually accepted Jesus as your
Savior? ___
Give a brief description of circumstances, date, place, who assisted,
Bible verses used, and so forth.
_____________________________________________________________________________
_____________________________________________________________________________
3. If you were to die today, and God should ask you why He should let you into heaven, what would you say? ___________________________________________________________________________
_________________________________________________________________________
5. Write a brief statement of purpose (1/2 page) on why you desire to attend Fairwood Bible Institute. What do you hope to receive? What are your goals? You could also include how you heard of Fairwood, how long you plan to attend, or what made you decide to enroll. (use a separate piece of paper or blank portion of application form.)
IV.
References:
(Please
list three references below. Send a recommendation form to two of the following
of the three. Ask them to send it
directly to Fairwood Bible Institute Adm., PO Box 445, Dublin, NH 03444)
1. Pastor: Name____________________________ Church____________________________
Address__________________________ City________ State___ Zip_____ Phone________
2. Name____________________________________________________
Address_______________________ City________ State_____ Zip_____ Phone_________
3. Name____________________________________________________
Address_______________________ City________ State_____ Zip_____ Phone_________
V. Health Information:
1.
Do you have any health condition or physical handicap which requires special
attention?_____
If yes, explain
2. Do you take any medication on a regular basis?____ If yes, what?_____________________
VI.
Education:
Circle
the year completed: High School 9 10 11 12 College 1 2 3 4 Post Grad.
Masters Doctoral
1.
High School_________________________ Date Graduate(d)______ Date Withdrew_____
Address__________________________________________________ Phone
___-____-_____
2. Name (schools since High School) Date entered Date withdrew Date Graduated Degree
___________________________________________________________________________
_________________________________________________________________________
3. When would you like to attend Fairwood? ___as soon as accepted ___Fall term 20__ Winter term 20___ by (date)____________
VII.
Commitment
Please
read the following statement carefully. Your signature below certifies
your acceptance of and agreement with all three.
1. I give my permission for any of my records be reviewed for the purpose of determining my acceptance at Fairwood Bible Institute. This could include school records, police/court records, financial records, etc.
2. I have read the student rules in the handbook and am willing to accept the standards, rules and regulations of Fairwood Bible Institute.
3. I certify that, to the best of my knowledge, the information given on this application is complete and accurate.
Signed______________________________________________________ Date_____________
VIII.
PARENT'S COMMITMENT
(Optional)
I
have read or am familiar with the standards, rules and regulations of Fairwood
Bible Institute and will support my son/daughter in his/her commitment to abide
by them.
Signed
__________________________________________________Date________________
(Parent or
Guardian)