Bible Institute Registration — The Southern California Fourth Ecclesiastical Jurisdiction

Student Information

Name

Name of Student

First Name

Last Name

Phone

(###)

###

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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

(###)

###

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Do you have your Pastors consent?

This will be needed for Ordination/Licensing but is not required to enroll in the College.

YES