Ambassador Bible College Admissions Application Page 1 of 4

Ambassador Bible College P.O. Box 54992 Cincinnati, OH 45254-0992 Phone: (513) 576-9796 Fax: (513) 576-9794

Application for Admission

PERSONAL INFORMATION Name _______________________________________________________________________________________

Last (Family) First Middle Suffix (Jr., Sr., etc.) Birth Date _________________________ £ Male £ Female Marital Status _________________________

(mm/dd/yyyy) (single, married, etc.) PERMANENT ADDRESS ____________________________________________________________________________________________

Street Address Apartment # ____________________________________________________________________________________________

City/Town State/Province Country Zip/Postal Code Cell Phone (_______) __________________________ Home Phone (_______) _________________________ Work Phone (_______) _________________________ Email _______________________________________ Please give your current address for all admission correspondence, if different from above. CURRENT MAILING ADDRESS ____________________________________________________________________________________________

Street Address Apartment # ____________________________________________________________________________________________

City/Town State/Province Country Zip/Postal Code CITIZENSHIP Place of Birth _________________________________________________________________________________

City/Town State/Province Country £ US Citizen £ Dual US citizen; please specify other country of citizenship __________________________

£ US permanent resident visa; citizen of ____________________ Alien registration number ________________

£ Other Citizenship __________________________________________________________________________ Visa

If you live in the United States, but are not a U.S. citizen, how many years have you lived in the country? ________ If not English, language spoken in your home ___________ If not English, list your first language ___________

Attach a recent

photograph of yourself

here

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ETHNICITY Race/Ethnicity information is optional. Information you provide will not be used in a discriminatory manner.

How would you describe your racial background? (Select one or more of the following categories):

£ American Indian or Alaska Native £ Hispanic or Latino

£ Asian (country of family’s origin ) £ Native Hawaiian or Other Pacific Islander

£ Black or African American £White

ACADEMIC INFORMATION School ______________________________________________________________________________________

Type of school: £ Public £ Private £ Correspondence £ Parochial £ Home School £ Other School Address ______________________________________________________________________________

Street Address Apartment #

____________________________________________________________________________________________ City/Town State/Province Country Zip/Postal Code

Start Date ______________________________ Date of Graduation _____________________________________ Counselor’s Name ______________________________ Phone (_______) ________________________________ Counselor’s Email ______________________________ Fax (_______) _________________________________

Are you currently enrolled in school? £ Yes £ No

Will/did you graduate from High School early? £ Yes £ No

Did you receive a GED? £ Yes £ No If so, list date: ________________________________

If your education has been interrupted, please detail your activities since last enrolled. Please attach your response to the end of the application.

OTHER HIGH SCHOOLS

School Name Dates Attended Location

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ COLLEGES / UNIVERSITIES

School Name Dates Attended Location

____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

Transcript of scholastic record attached? £ Yes £ No

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ACADEMIC DISTINCTIONS

Please list any academic or educational awards and honors you received in high school or college (e.g. National Merit, National Honor Society). Please attach your response to the end of the application.

EXTRA CURRICLULAR AND VOLUNTEER INFORMATION (including summer)

Please list any significant extracurricular, community activities or hobbies in which you have participated. Include specific accomplishments such as musical accolades, athletic distinctions, etc. (Please note: “PG” means Post-Graduate) Feel free to attach additional information to the end of the application.

Activity Grade Level Specific Accomplishments Hours/ Weeks/ week year

________________________________ £10 £11 £ 12 £PG ______________________________ ____ ____ ________________________________ £10 £11 £ 12 £PG ______________________________ ____ ____ ________________________________ £10 £11 £ 12 £PG ______________________________ ____ ____ ________________________________ £10 £11 £ 12 £PG ______________________________ ____ ____ ________________________________ £10 £11 £ 12 £PG ______________________________ ____ ____

EMPLOYMENT INFORMATION

List any work experience you’ve had (including summer jobs) during the past three years.

Employer Job Description Dates of Employment Hours/week ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

PERSONAL STATEMENT

Please write an autobiographical essay. Be sure to include experiences that have shaped your character and why you wish to attend Ambassador Bible College. Please attach your response to the end of your application.

ACTIVITY DESCRIPTION

Tell us more about one of your extracurricular, volunteer, or employment activities. This short description could include your participation in the arts, church, clubs, community, dance, hobbies, media, music, sports, theater, etc. Please attach your response to the end of the application.

MULTIMEDIA INFORMATION (optional)

You may provide a link to any online content you feel: 1. Tells us more about yourself 2. Demonstrates a particular talent you possess 3. Highlights an activity in which you participated. Ideas include a link to an online video you created, a portfolio (pictures or photographs), a musical composition or performance, or an article or blog. http:// _____________________________________________________________________________________

Please briefly describe the contents of the link you provided:

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DISCIPLINE INFORMATION Have you ever been placed on probation, suspended, dismissed or expelled from any school or academic program since 9th grade? £Yes £ No Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime? £Yes £ No If you answered yes to either question, please provide an explanation and the approximate dates of each incident. Please attach your response to the end of the application.

REFERENCES 1. _____________________________________ ____________________ (____) __________________

Name Relationship to you Phone 2. _____________________________________ ____________________ (____) __________________

Name Relationship to you Phone 3. _____________________________________ ____________________ (____) __________________

Name Relationship to you Phone

AUTHORIZATION Your signature below 1. authorizes Ambassador Bible College to review of your application for the admission process. 2. confirms all information in this application (including any supplemental information) is factually true and honestly presented and that you are the person submitting this application. 3. confirms that your enrollment will not be complete, even if otherwise accepted into the program, until the full tuition payment of $2,500.00 is received before attending any classes. Signature of applicant __________________________________________________________ Date ____________

Please return this completed application with your $25.00 application fee (that will be applied toward your tuition, if accepted) to the following address:

Ambassador Bible College P.O. Box 54992

Cincinnati, OH 45254-0992 This institution is not certified by the Board of Regents or the State of Ohio.