Student Application
Name *
Name
Address *
Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Birthdate *
Birthdate
Family Information
Father/Guardian Name
Father/Guardian Name
Mother/Guardian Name
Mother/Guardian Name
Guardian Address
Guardian Address
Church Information
Church Address
Church Address
Church Phone *
Church Phone
Senior Pastor *
Senior Pastor
Include when and how you became a Christian.
Academic Background
Employment History
Date Hired
Date Hired
Date Hired
Date Hired
Financial Information
Check all of the following resources that you might use to pay for your academic tuition.
Pastoral Reference
Name *
Name
Phone *
Phone
Personal Reference
Name *
Name
Phone *
Phone
Personal Evaluation
Please give an honest estimation of yourself in the following areas. Rate 1-10 (10 being highest).
Personal History
Some of the following questions are a bit more personal. Please give an honest answer and understand that an affirmative answer does not necessarily prevent you from attending Anthem.
Drugs/illegal substances, underage drinking/alcohol abuse, tobacco, occult/any cult?
Pornography, homosexuality, eating disorder, severe depression, self-harm?
Today's Date *
Today's Date