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Please fill in all the blanks below. Required fields are marked with a check:

Associates Degree

A. Select your intended degree >

Please select one

Associate of Biblical Studies
Associate of Pastoral Studies
Associate of Missions & Evangelism
Associate of Christian Counseling

Associate of Christian Education
Associate of Christian Early Childhood Education
Associate of Christian Elementary Education
Associate of Christian Secondary Education

Telephone - Home:
Telephone - Work:
e-mail address:

Your Address:

Social Security Number:
Date of Birth:
Your Occupation:

* Active Military occupations receive tuition discount on monthly plans. Must provide military i.d. Discount is applied on monthly tuition and books. Enrollment fee is not discounted. Details Here

Married Yes No

Gender Male Female


Your Church:
Pastor's Name:
Pastor's Phone:
Pastor's e-mail:
Second Reference (non-relative):
Reference's Phone:
Reference's e-mail:


Education (High School Graduation or GED required):

High School Attended:


Year Graduated:

Colleges & Bible Institutes Attended (Name, City, State, Degree Earned, Date Graduated)

Total College Credit Hours Earned:


Christian Testimony & Ministry:

Please briefly summarize your salvation experience:

How many years have you been active in church work?

What is your previous ministry experience (check all that apply):

Church Staff
Sunday School Teacher
Christian School Teacher
Christian School Admin
Christian Counseling


Do you plan to graduate from Patriot Bible University? Yes No

Who (or which search engine) referred you to Patriot Bible University?

Agreement with Statement of Faith

Patriot Bible University stands for the fundamentals of the faith: the verbal inspiration of the Bible, the deity of Christ, His virgin birth, His blood atonement, His bodily resurrection, salvation by grace through faith in Christ and the bodily return of our Lord Jesus Christ to set up His eternal kingdom.

Do you agree with the preceding Statement of Faith?
Yes No

Commitment to Personal Holiness

Will you make a diligent effort to pray and read God's Word daily, to faithfully
attend a Bible-believing church, and to honor the Lord by abstaining from sinful acts?
Yes No

Statement of Understanding

I understand that Patriot Bible University is a religious school. Credits are not guaranteed to be accepted by secular or state-run programs. I also understand that Accrediting Commission International is a private school organization unrelated to government accreditation. I acknowledge that I have read this >disclaimer<.
Yes No

You are now ready to check this application for completeness: