Student Information Name * Name of Student First Name Last Name Email * Phone * (###) ### #### Title The title you are seeking or currently holding if you are a returning student. Church Information Fill in the information for the church that you attend. Please have either your Pastor's phone number or email address. Church Name * Pastors' Name First Name Last Name Pastors' Phone (###) ### #### Email Do you have your Pastors consent? * This will be needed for Ordination/Licensing but is not required to enroll in the College. YES NO Thank you for registering for the Southern California Fourth Jurisdiction Bible Institute!
