APPLICATION FOR ADMISSION TO DOCTORATE PROGRAM
Please fill in all the blanks below. Required fields are marked with a check:

Which degree do you desire to pursue? Prerequisite: Bachelors and Masters degree required for the following: Admissions Policies Doctor of Ministry in Biblical Studies Doctor of Ministry in Pastoral Studies Doctor of Ministry. in Christian Counseling Doctor of Ministry in Christian Education

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

Your Address:
City/State/Zip:

Social Security Number:
Date of Birth:
Your Occupation:

Married Yes No

Gender Male Female

References:

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:

City/State:

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):

Pastor
Church Staff
Deacon
Sunday School Teacher
Missionary
Evangelist
Christian School Teacher
Christian School Admin
Christian Counseling
Other

Feedback:

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: