Antioch Baptist Seminary

P.O. Box 3451, Lawrenceburg, IN 47025

Phone: 1-866-553-0507

Please type or print.

Name______________________________________________ Date________________

            Last                                First                        Middle            

Address_________________________________________________________________

                Street                                            City                         State                            Zip

Home Phone (_________)_______       Business Phone (_________) ___________________

Date of Birth ______/______/___ Total Years in the Ministry ___Sex: Male ____Female____

Social Security Number_______________________Race______________________

Are you a pastor?__________ Name of your church_______________________

Why do you want this education?______________________________________

Student Evaluation

The admission’s office will evaluate all information given and transfer the acceptable credit hours to Antioch Baptist Seminary.  If you are applying for any degree other than the associate, please mail an original copy of your transcript in a sealed envelope or a photocopy of your degree with your application.

Please list below all colleges, universities, and seminaries attended:

Your application and evaluation will be processed by the admission’s office.  The admission’s office will determine the number of transferable credits from your transcript and determine the level of your degree program.  Please indicate below the degree program for which you are applying.

_____________________________             ________________________________

Applicant’s Signature               Date                   President’s Signature                Date

Make checks payable to Antioch Baptist Seminary and mail with your application.

Referred by________________________________________________________