Online Application | Kentucky Mountain Bible College

This application will take between 7-20 minutes to complete.
You will need names and contact information for those you are choosing as references.
It works best to complete the application in one sitting.
Personal Information
Name*
First Middle Last
Preferred Name
If you prefer to go by a name other than your first name
Gender*
- Male
- Female
I am a(n):*
- U.S. Citizen
- Permanent Resident of U.S.
- International Student
Address*
Street Address City State ZIP Code
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Type of Visa*
Main Phone*
Main Phone with Country Code*
Alternative Phone (if available)
Can we text you?*
- Yes
- No
Email*
Social Security Number
Please enter your SSN with dashes. Example: 123-45-6789 This field is encrypted and secured.
0 of 11 max characters
Birth Date*
Month
Day
Year
Current Age*
Please enter a number from 12 to 105.
Please upload a recent photo of yourself.
Max. file size: 50 MB.

Admissions Information
I intend to study:*
- On Campus
- Online
I am applying to be a:*
Year*
Term*
Status*
Academic Interest*
Educational Background
Year of High School Graduation*
0 of 4 max characters
Type of High School*
Name of High School*
City*
State*
Country*
Have you taken a Standardized Test (ACT / SAT / CLT)?*
- Yes
- No
- I have a date scheduled
Have you taken the TOEFL?*
- Yes
- No
- I have a date scheduled
Composite Score (if available)
Score (if available)
List all colleges you have attended or are attending:
Name of College or University Dates Attended (From/To) City, State Credits Earned
Please Initial*
I authorize the above schools to release my social and disciplinary activity record to Kentucky Mountain Bible College. I waive my right to view the submitted reference and will not hold the submitter liable for the information included, provided it is factual.

Family Information
Parent / Guardian
First Last
Parent / Guardian Phone
Parent / Guardian Phone with Country Code
Parent / Guardian Email
Reference Information
Please provide contact information for three (3) adults who will fill out references for admission. One of these should be your pastor. The other two can include, but are not limited to: 1) a teacher, 2) your boss, 3) a coworker. No family member may fill out a reference for you.
Reference #1 - Pastoral Reference*
If you are a pastor, or your pastor is a family member, you may provide another person who can provide a spiritual reference for you.
First Last
Email
Phone
Reference #2*
First Last
Email
Phone
Reference #3*
First Last
Email
Phone

Signature and Endorsements
Read the following statements and check the box if you are in accordance with each one:
I hereby make application to Kentucky Mountain Bible College and certify that all information submitted in the admission process is my own work, factually true, honestly presented, and that any documents submitted will become the property of KMBC and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree, should the information I have certified to be false. I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school, and a clear or unchanged criminal record. I understand that KMBC may perform a background check to verify current records.*
- Yes
- No
As a student of Kentucky Mountain Bible College, I understand and agree to uphold the core values, Mission Statement, and Doctrinal beliefs of the institution. I understand and agree to abstain from the use of alcohol, tobacco, illegal drugs, and anything that would defile sexual purity as God ordained, one man and one woman exclusively. If admitted, I agree to subscribe willingly and faithfully to all policies and standards of the college.*
- Yes
- No
Applicant's Typed Signature*
Please type your name as a digital signature. If the person who fills out this line is not the applicant, the entire application becomes invalid.
This field is hidden when viewing the form
Applicant Signature
Sign with your actual signature using your touchscreen device or mouse.
Date*
MM slash DD slash YYYY
CAPTCHA
Kentucky Mountain Bible College admits and administers programs without discrimination on the basis of race, color, gender, age, national or ethnic origin, handicap, or status as a veteran.
Email
This field is for validation purposes and should be left unchanged.

Step 1 of 5 - Personal Information

Personal Information

Admissions Information

Educational Background

Christian Experience

Background

Family Information

Reference Information

Signature and Endorsements

Read the following statements and check the box if you are in accordance with each one:

Kentucky Mountain Bible College admits and administers programs without discrimination on the basis of race, color, gender, age, national or ethnic origin, handicap, or status as a veteran.

Name of College or University	Dates Attended (From/To)	City, State	Credits Earned