ENROLLMENT APPLICATION

SERVICES & BROADCASTS

Sunday Morning Worship
8:30 a.m. & 11 a.m.

Wednesday Bible Study
7 p.m.

Television Broadcast
Coming Soon!

Radio Broadcast
WREJ – AM (1540)
8:45 – 9:00 a.m.

WVTJ – Pensacola, FL

KXKS – Albuquerque, NM
9:30 – 9:45 a.m.

WLMR – Chattanoogo, TN
6:15 – 6:30 p.m.

WSKY – Asheville, NC
6:30 – 6:45 p.m.

Healing Service
NO HEALING SERVICE (Until Further Notice)

Application for Enrollment 2008

Please fill out the following Enrollment form. We will contact you shortly afterwards to confirm the submission and answer any additional questions you may have!

Please Note: ^* Denotes required fields!
Personal Information
Name^*
Address^*
City, State, Zip^*	,
Marital Status^*
Date of Birth^*	(mm/dd/yyyy)
Gender^*
Home Phone^*	(123-456-7890)
Work Phone^*	(123-456-7890)
Daytime Phone^*	(123-456-7890)
Fax	(123-456-7890)
E-mail^*
Do you have credentials for ministry?^*	Yes No
If Yes, what Church do you hold credentials with?
Information on Previous Education Personal Information
List all schools attended (including High School and credits or degrees)
Institution #1^*
Location #1^*
Years Attended #1^*
Degree Earned #1^*

Institution #2
Location #2
Years Attended #2
Degree Earned #2

Institution #3
Location #3
Years Attended #3
Degree Earned #3

Institution #4
Location #4
Years Attended #4
Degree Earned #4

Institution #5
Location #5
Years Attended #5
Degree Earned #5
Application Fee Schedule (Please note that no applications will be processed without the appropriate fees)
Application Fee:^*	$60.00
Assessment Fee:	$45.00 (Not Required!) (Assessment will be processed only after student has been accepted into a degree program. Please see site director or catalog for instructions on how to obtain credit for Ministry Life Experience (MLE)
Total Payment^*
Payment Method:^*
	I will send in a check or money order for the total made payable to: MOBCC Please charge my
For Credit Card Payments Only:
Card Number	(no dashes)
CVV2 Number	(3 digit number on back of card)
Expiration Date	(mm/yy)
Authorization	I authorize MOBCC to charge my credit card for the amount listed above
STCC Student Covenant:^*
	I certify that the information presented on this application is true and accurate to the best of my ability. Furthermore, I am in agreement with the MOBCC Statement of Faith and I agree to abide by the policies of the School as outlined in the MOBCC catalog. I also agree to lift the School, its professors, staff and students up before the Lord in prayer daily.
Any Additional Comments/Questions:
Comments
^*required

SERVICES & BROADCASTS

Application for Enrollment 2008

Personal Information

Information on Previous Education Personal Information

Application Fee Schedule

Payment Method:*

STCC Student Covenant:*

Any Additional Comments/Questions:

Payment Method:^*

STCC Student Covenant:^*