Applicant Information

Last Name *

First Name *

Middle Name *

What is your current high school status? *

Year of High School Graduation/GED *

Type of High School Attended *

Have you attended college or school beyond high school? *

Do you intend for your transcripts to be evaluated for potential credits to transfer to Heartland Baptist Bible College? *

Although Heartland cannot guarantee a timeline to graduation, do you intend for the transfer credits to enable you to complete your program sooner than the default timeline? *

Please list the school's name, city, and state of all institutions attended beyond high school. *

School 1
School 2
School 3
School 4
School 5

Have you ever been dismissed from school or placed on probation for ACADEMIC reasons? *

If yes, please explain: *

Have you ever been dismissed from school or placed on probation for DISCIPLINARY reasons? *

If yes, please explain: *

Are you now or have you ever been under the supervision of a parole officer or under the custody of a juvenile or any other court? *

If yes, please explain: *

Have you ever had a police record? *

If yes, please explain: *

Are you single or married? *

Single

Married

Parental Information

Father's Name *

Father's Address *

Is he your legal gardian? *

Is your father deceased? *

What is the date of your father's passing? *

Mother's Name *

Mother's Address *

Is she your legal guardian? *

Is your mother deceased? *

What is the date of your mother's passing? *

Are your parents separated? *

Please give the date of their separation. *

With whom are you living? *

Legal Guardian Name & Address *

Will you be married before enrolling? *

Please give the wedding date and spouse's name. *

Will you need a room reserved in the residence hall? *

Yes

If no, list the address and name of the person you will be living with. *

Married Student Information

Spouse's Name: *

Number of children? *

Names of Children *

Other Information

Have any members of your immediate family attended or graduated from this college, or are they attending now? *

List those members of your immediate family and their relationship to you. *

Who influenced you to apply to Heartland? *

Have you personally accepted Christ as Saviour? *

Yes

When? *

Give a brief testimony of salvation to include the basis of your salvation and your call to Christian Service. *

Heartland's Distinctives and Doctrines

Are you in accord with the doctrines for which this college stands? *

Yes

If no, please explain what doctrines you are not in agreement with and why: *

I certify that the information I provided in this form is true, complete, and accurate to the best of my knowledge.

Signature *

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4700 NW 10th St, Oklahoma City, OK 73127 | (405) 943-9330