PERSONAL INFORMATION
Date:
Last Name:
First Name:
Middle Name:
Gender:
Select One:
Male
Female
Home Address:
City (H):
State (H):
Zip (H):
Present Address:
City (P):
State (P):
Zip (P):
Birthdate:
Birthplace (City):
Birthplace (State):
Email:
Home Phone:
Cell Phone:
I prefer to be contacted by:
Select One:
Home Phone
Cell Phone
Email
Citizen of:
Select One:
USA
Other
Country (if OTHER):
If OTHER, give type of resident:
Select One:
Student Visa
Permanent Visa
Other Visa
Check here if you are a resident alien.
(Please send a copy of your resident alien card.)
Church Name:
Chuch Denomination:
Church Address:
City:
State:
Zip:
Pastor's Name:
Church Phone:
Pastor's Email:
Have you accepted Christ as your personal Savior?
Select One:
Yes
No
Are you a member of a local church?
Select One:
Yes
No
Are you essentially in agreement with the doctrinal statement of the College ?
Select One:
Yes
No
If no, please indicate the area:
FAMILY INFORMATION
(OPTIONAL if you are married, or an
independent student)
Father's Full Name:
Living?
Select One:
Yes
No
Father's Occupation:
Father's Address:
City:
State:
Zip:
Phone:
Mother's Full Name:
Living?
Select One:
Yes
No
Mother's Occupation:
Mother's Address:
City:
State:
Zip:
Phone:
If parents are divorced, with whom do you live?
Select One:
Father
Mother
Other
Siblings?
Brothers:
Select One:
Yes
No
Sisters:
Select One:
Yes
No
Has any relative attended LBC?
Select One:
Yes
No
Relationship:
EDUCATIONAL INFORMATION
Your purpose in wanting to attend LBC:
Plan to attend:
Semester:
Fall
Spring
Year:
Status:
Full-Time
Part-Time
Resident
Commuter
Degree/Certificate:
Bachelor of Science
Associates Degree in Science
One Year Certificate
Desired Area of Study:
Professional Counseling Program
Social Work Program
BS/MEd School Counseling Program (5-year)
Children and Family Ministry Program
Christian Ed. and Discipleship Program
Church Planting Program
Pastoral Ministry Program
Student Ministry
Women in Christian Ministries Program
Health and Physical Education Program
Sports Management/Ministry
Cross-Cultural Ministry
TESOL
Music Performance
Worship Arts
Music Education Program
Bible Education Program
Early Childhood Education (PK-4, K-8)
Elem./Middle School Generalist(4-8, K-8)
Elem./Middle School Specialist(4-8, K-8)
Teacher Certification Program
Assoc. Degree in Bible - Two Year
Bible Ministries (A.S.) - Two Year
Bible Ministries (B.S.) - Four Year
Concentrated Bible Course - 1 Year
LBC Certificate Program - 1 Year
UNDECIDED
High School Name and Address (city, state, zip):
High School Graduation Date:
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Course of Study:
Academic
Business
General
Vocational
List ALL colleges, universities, and community colleges attended
(include dates attended and degrees received. If no colleges attended, type N/A):
Please request official transcripts be sent from ALL institutions listed above.
Have you ever been dismissed or placed on probation? (If yes, please give a description in a separate email to )
Academic
Select One:
Yes
No
Disciplinary
Select One:
Yes
No
Have you applied, or are you applying for admission to any other college?
Select One:
Yes
No
If yes, where? (optional question for record keeping)
Who influenced you the most to consider LBC?
Parent
LBC Student
LBC Alum
LBC Faculty
Pastor
High School Teacher
Other
Name of this influential person:
ACTIVITIES
(This section is used to determine
eligibility for scholarships)
Varsity sports in which you participated:
Put the number of years involved after each
sport.
Captaincy, letter earned, or awards?
Select One:
Yes
No
Are you planning to participate in LBC's athletic program?
Select One:
Yes
No
If yes, which sports are you interested in playing:
Men's
Basketball
Baseball
Soccer
Cross-Country
Volleyball
Women's
Basketball
Lacrosse
Soccer
Cross-Country
Volleyball
Musical activities in which you participated:
Put the number of years involved after each
activity.
Are you planning to participate in LBC's music program?
Select One:
Yes
No
If yes, which ensembles are you interested in playing:
Worship Teams
Chorale (Conestogans)
Chamber Singers
"Hearts of Praise" Worship Choir
LBC Chamber Orchestra
Handbell Choir
Instrumental Ensembles
Lancaster County Jazz Company
Auditions may be required for participation.
Do you play a musical instrument?
Select One:
Yes
No
If yes, what instrument?
Other school activities in which you participated:
Debating
Drama
Magazine
Newspaper
Student Government
Yearbook
Church activities in which you participated:
Community activities in which you participated:
Honors/Awards/Leadership:
FINANCES
How do you plan to finance your first year in college?
Savings
Parents
Grants/Loans
Part-Time Work
Other
Are you eligible for any benefits?
Social Security
Veterans Admin.
OVR
Other
Have you filed the Free Application for Federal Student Aid?
Select One:
Yes
No
If yes, please enter date FAFSA was filed:
LIFESTYLE STANDARDS
Have you used tobacco, alcohol or drugs in the past?
Select One:
Yes
No
If yes, explain:
Have you ever been charged with a criminal offense?
Select One:
Yes
No
If yes, explain:
PERSONAL TESTIMONY
Please tell us a little about yourself (include family background, school/work experience, church or community involvement):
Please tell us how you came to know Christ as your Savior (a clear salvation experience), and a little about your walk with the Lord: