Step 1

Personal Information

As each step in your application is finished, it will be submitted to Elim Bible Institute and filed until the entire application is completed. If you need to stop and come back to your application later, finish and submit the page you were working on. You can start where you left off at a different time.

Personal Information

*Last Name:

*First Name:

*Middle Initial:

Preferred Name:

*Gender:

*Ethnicity:

*E-mail Address:

Birthdate: (Mo./Day/Yr.)

Country of Citizenship:

If you are not a U.S. or Canadian citizen, do you have a current U.S. visa?

If Yes, What Type?

Visa expiration date (Mo./Day/Yr.):

(International Students: Please provide a copy of visa and current I-94)

Indicate Program to which you are applying

Diploma Program:

3-Year On-Campus Program
Missions & International Community Health
Draw From The Well
Practical Ministry & Missions (2-Yr)

Date you wish to enter Elim Bible Institute:

Mailing Address

*Address:

City:

State/Prov:

Zip/Postal Code:

Country:

Phone (Home):

Phone (Work):

Phone (Cell):

Permanent Address: (if different from above)

Address:

City:

State/Prov:

Zip/Postal Code:

Country:

Family Information

Father/Guardian's Name:

Living Deceased

Address:

City:

State/Prov:

Zip/Postal Code:

Phone Number:

Mother/Guardian's Name:

Living Deceased

Address:

City:

State/Prov:

Zip/Postal Code:

Phone Number:

* Please write a brief explanation. Divorce, itself, will not hinder your acceptance as a student.

Student Families

If you are a married applicant, or a single applicant with dependent children please fill out the following:

Date of Marriage: (Mo./Day/Yr.)

Spouse's Name:

Spouse's Birthday: (Mo./Day/Yr.)

Do you expect to bring your family to Elim?

If no, please explain:

List the name, gender, age and birthdate of your children:

Name	Gender	Age	Birthdate

Please ask your spouse to send a letter to admissions@elim.edu indicating his/her Christian experience and commitment and his / her feelings about your coming to Elim.

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