Enrollment Information


Program Applying for:

 Military & Law Enforcement Chaplain

 EMS Outreach Chaplain

 Biblical Studies

 Missions

 Church Administration

 Single Course


Biographical Information


First Name   Last Name   Middle Name


Permanent Address   City, State, ZIP


Email Address   Phone Number   Skype


Date of Birth   Place of Birth   Citizenship


Gender   Marital Status   Name of Spouse


Number of Children   Home Church   Pastor's Name


Church Address   City, State, ZIP   Phone


If you are seeking College Credit, is your Pastor willing to work with you to accomplish your tests?

 Yes    No    Not Seeking Credit


Is your family in agreement with your educational desires?

 Yes    No


If no, please submit details:



Have you ever been arrested?

 Yes    No


If yes, please submit details:



Parent/Next of Kin   Relationship


Address   City, State, ZIP   Phone


How do you intend to finance your education?:

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High School   Highest Grade Completed


Year   GED


School Address   City, State, ZIP   Phone


Other Education - List other schooling (College, Vocational, Business, etc.)

1. Name of School   Dates of Attendance


    School Address   City, State, ZIP   Phone


    Major   Degree or Diploma


2. Name of School   Dates of Attendance


    School Address   City, State, ZIP   Phone


    Major   Degree or Diploma


3. Name of School   Dates of Attendance


    School Address   City, State, ZIP   Phone


    Major   Degree or Diploma


References (other than relatives):


1. Pastor   Address   City, State, ZIP


    Phone   Email


2. Name   Address   City, State, ZIP


    Phone   Email


3. Name   Address   City, State, ZIP


    Phone   Email


How were you saved?:



Give a brief statement of your Christian service to date:

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What are your plans when you finish college?:



Why did you choose Dayspring Bible College & Seminary Distance Learning?:



By clicking send you agree that �I do hereby make application for the Dayspring Bible College & Seminary Distance Learning Program, and agree, if accepted, to cheerfully abide by all rules and regulations and cooperate fully in every respect in advancing the Christian testimony of the Dayspring Bible College & Seminary. I have read the Catalog, including the Statement of Faith, and am in full agreement with its policies, procedures, and other information contained therein.�