Online Application

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*
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)
Please upload a recent photo of yourself.

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Educational Background
Year of High School Graduation*
Type of High School*
Name of High School*
City*
State*
Country*
Have you taken the ACT?*
- Yes
- No
- I have a date scheduled
Have you taken the TOEFL?*
- Yes
- No
- I have a date scheduled
Composite Score (if available)
Score (if available)
List all colleges you have attended or are attending:
Name of College or University Dates Attended (From/To) City, State Credits Earned
Please Initial*
I authorize the above schools to release my social and disciplinary activity record to Kentucky Mountain Bible College. I waive my right to view the submitted reference and will not hold the submitter liable for the information included, provided it is factual.
List high school, college, and/or community activities you have participated in.

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Family Information
Siblings (Please give names, ages, and level of schooling of your brothers and sisters).
Name Age Grade Level or College Year
Parent Information
Father's Name
First Last
Father's Address
Street Address City State ZIP Code
Father's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Father's Home Phone
Father's Cell Phone
Father's Home Phone with Country Code
Father's Email
Mother's Name
First Last
Mother's Address
Street Address City State ZIP Code
Mother's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Mother's Home Phone
Mother's Home Phone with Country Code
Mother's Cell Phone
Mother's Email
Are your parents in support of your coming to KMBC?*
- Yes
- No

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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.
Applicant Signature
Sign with your actual signature using your touchscreen device or mouse.
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA
Note: If applicant is under 18 years of age at enrollment, a parent/guardian is also required to endorse the following statement.
I will be supportive of the policies and standards of Kentucky Mountain Bible College as desire my son/daughter to attend this college.
Parent/Guardian Signature
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.
Phone
This field is for validation purposes and should be left unchanged.

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Personal Information

Admissions Information

Financial Information

Educational Background

Christian Experience

Background

Family Information

Parent Information

Reference Information

Signature and Endorsements

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

Note: If applicant is under 18 years of age at enrollment, a parent/guardian is also required to endorse the following statement.
I will be supportive of the policies and standards of Kentucky Mountain Bible College as desire my son/daughter to attend this college.

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.

Employer	Occupation	Years of Employment

Name of College or University	Dates Attended (From/To)	City, State	Credits Earned

Name	Age	Grade Level or College Year

Personal Information

Admissions Information

Financial Information

Educational Background

Christian Experience

Background

Family Information

Parent Information

Reference Information

Signature and Endorsements

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

Note: If applicant is under 18 years of age at enrollment, a parent/guardian is also required to endorse the following statement.I will be supportive of the policies and standards of Kentucky Mountain Bible College as desire my son/daughter to attend this college.

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.

Note: If applicant is under 18 years of age at enrollment, a parent/guardian is also required to endorse the following statement.
I will be supportive of the policies and standards of Kentucky Mountain Bible College as desire my son/daughter to attend this college.