Application to Salt Lake Baptist College

Please fill out the following information and click the submit button. "*" indicates mandatory fields.

*Student First Name
*Last Name
*Address
Address2
*City
*State
 
*Zip Code
Country
 
*Email
*Verify Email
*Social Security Number - last 4 digits only (if you don't have one, enter NONE):
*Phone Number (If out of U.S. include country code)

PERSONAL INFORMATION
*Date of Birth (mm/dd/yyyy use numbers)
*Sex
(M) (F)
*How long have you been saved? (Number of years only)
*Are you a member of a Church?
Yes No

CHURCH INFORMATION
If you are NOT a member of a Church, please enter NONE in the Church information fields below.
If you ARE a member of a Church, please fill out the following information. (Do not us abbreviations.)
*Name of Church
*Church Address
*Church City
State: 
*Church Zip
*Church Phone
*Name of Church Pastor
Pastor Phone:
( )   -

ACADEMIC INFORMATION
High School (or equivalent in your country) from which you graduated or GED.
If you do NOT have a high school diploma, enter NONE in the School fields.
*Name of School
*Complete address of School.
*School Country: Other:  
*School Phone number
*Date Graduated (mm/dd/yyyy use numbers)
*Did you get a GED?
Yes No
*Date of GED (mm/dd/yyyy use numbers.) (Enter NONE if you don't have a GED.)