Student Enrollment Form
FIRST, MIDDLE and LAST NAME*
DATE OF BIRTH (##/##/####)*
AGE*
SEX*
EMAIL ADDRESS*
ALTERNATE EMAIL*
DAY TIME PHONE*
CELL PHONE*
CURRICULUM APPLYING FOR*
 Bachelor
 Master
 Doctorate
 College of the Prophets
 LEAD Program
PAYMENT PLAN*
 College of the Prophets Full - $675.00
 College of the Prophets Monthly - $225.00
 Bachelor Degree Full - $7,200.00
 Bachelor Degree Monthly - $150.00
 Master Degree Full - $7,200.00
 Master Degree Monthly - $150.00
 Doctoral Degree Full - $10,000.00
 Doctoral Degree Monthly - $250.00
 LEAD Program Evaluation and Assessment - $100
WOULD YOU LIKE INFORMATION ABOUT SCHOLARSHIP OPTIONS?*
 YES
 NO
ARE YOU IN MINISTRY?*
 YES
 NO
IF IN MINISTRY, WHAT IS YOUR PASTOR'S NAME AND MINISTRY NAME? PLEASE PROVIDE EMAIL ADDRESS AND WEBSITE ADDRESS.*
PROVIDE THE NAME, PHONE NUMBER AND EMAIL ADDRESS OF 3 REFERENCES IN THE BOX BELOW.*
WHAT ARE YOUR MINISTERIAL GOALS AND WHY DO YOU WANT TO ATTEND EXOUSIA BIBLE COLLEGE?
ARE YOU AN ORDAINED MINISTER? *
CAN YOU LIST THREE OTHER PEOPLE WHO WOULD BE INTERESTED IN EXOUSIA BIBLE COLLEGE? PLEASE LIST THEIR NAME, PHONE NUMBER AND EMAIL ADDRESS?


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Exousia Bible College. The Future of Theology.