Application for Audit - www.kmbc.edu

This application will take between 15-45 minutes to complete.
This form does not save your data. Please complete the application in one sitting.
Personal Information
Name*
First Middle Last
Preferred Name
If you prefer to go by a name other than your first name
Gender*
- Male
- Female
I am a(n):*
- U.S. Citizen
- Permanent Resident of U.S.
- International Student
Address*
Street Address City State ZIP Code
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Type of Visa*
If none, put N/A or "None"
Main Phone*
Main Phone with Country Code*
Fax Number with Country Code
Alternative Phone (if available)
Can we text you?
- Yes
- No
Email*
Social Security Number*
Please enter your SSN with dashes. Example: 123-45-6789 This field is encrypted and secured.
Birth Date*
Current Age*
Please enter a number from 12 to 105.
Marital Status (optional)

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Reference Information
Please provide contact information for three (3) adults who will fill out references for admission. One of these should be your pastor. The other two can include, but are not limited to: 1) a teacher, 2) your boss, 3) a coworker. No family member may fill out a reference for you.
I understand that people prefer references to be private, and I willingly waive my right to view the completed reference form knowing that this waiver will not influence the College’s admission decision.*
If you select "no", people may be unwilling to provide a reference for you.
- Yes
- No
Reference #1 - Pastoral Reference*
If you are a pastor, or your pastor is a family member, you may provide another person who can provide a spiritual reference for you.
First Last
Email
Phone
Reference #2*
First Last
Email
Phone
Reference #3*
First Last
Email
Phone

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Signature and Endorsements
Read the following statements and check the box if you are in accordance with each one:
I hereby make application to Kentucky Mountain Bible College and certify that all information submitted in the admission process is my own work, factually true, honestly presented, and that any documents submitted will become the property of KMBC and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree, should the information I have certified to be false.*
- Yes
- No
As a student of Kentucky Mountain Bible College, I understand and agree to uphold the core values, Mission Statement, and Doctrinal beliefs of the institution. I understand and agree to abstain from the use of alcohol, tobacco, illegal drugs, and anything that would defile sexual purity as God ordained, one man and one woman exclusively.*
- Yes
- No
I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school, and a clear or unchanged criminal record. I understand that KMBC may perform a background check to verify current records.*
- Yes
- No
If admitted, I agree to subscribe willingly and faithfully to all policies and standards of the college.*
- Yes
- No
Applicant's Typed Signature*
Please type your name as a digital signature. If the person who fills out this line is not the applicant, the entire application becomes invalid.
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Applicant Signature
Sign with your actual signature using your touchscreen device or mouse.
Date*
MM slash DD slash YYYY
Date
Kentucky Mountain Bible College admits and administers programs without discrimination on the basis of race, color, gender, age, national or ethnic origin, handicap, or status as a veteran.
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Name
This field is for validation purposes and should be left unchanged.

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Personal Information

Admissions Information

Educational Background

Christian Experience

Background

Reference Information

Signature and Endorsements

Read the following statements and check the box if you are in accordance with each one:

Kentucky Mountain Bible College admits and administers programs without discrimination on the basis of race, color, gender, age, national or ethnic origin, handicap, or status as a veteran.