Registration Form  


PLEASE PRINT & MAIL TO:  Christian Bible College, P.O. Box 8968, Rocky Mount, NC 27804

Name ____________________________________________________________________________
Sex:  _______Male       _______ Female Age: _______________
Address: ___________________________________________________________________________
City: ____________________________,  State: _________ Zip: ____________________
Home Phone: ( ______ ) __________________    Work Phone: ( ______ ) _______________________
E-Mail Address: _____________________________________________________________________
Degree(s) now held: __________________________________________________________________
Which Program would you like to enroll? _________________________________________________

What name do you desire to appear on your Degree?  (Please use exact spelling of your name)          


Occupation: _______________________________________________________________________
Employer: _________________________________________________________________________
Employer's Address: _________________________________________________________________
City: ____________________________   State: _________ Zip: ____________________


In consideration of Christian Bible College (CBC) accepting the undersigned as a student of its Christian Educational Program, the undersigned agrees to pay appropriate scheduled fees and acknowledges that no refund will be made. If financed by CBC, one payment per month is required unless other arrangements are made. If three (3) consecutive payments are missed the balance becomes payable in full. If not paid, CBC will no longer maintain student file.  All homework and full payment due within 24 months.  Until completion of all required degree work, the undersigned agrees not to claim they hold a degree from Christian Bible College, or use the degree title until any outstanding balances are paid in full and the degree has been officially awarded.

And in acceptance of this student's application and registration, Christian Bible College agrees to provide to the undersigned a course of Christian educational instruction in accordance with its regularly developed or special curriculum. Financial commitment is only for each one-year program.

Signature of Student: _______________________________________________________
This the ______ day of ________________ (month), ______(year).    Social Security # _________________

BONUS: Save 20% for cash payment on tuition and fees > Send (minimum) $360.00 to enroll

Down Payment: $__________________ Balance Due: $___________________

$_____________ per month until balance is paid in full, according to CBC Cost Schedule. First payment is due thirty (30) days after initial registration arrangements; remaining payments due same date each month thereafter.


© Christian Bible College • P.O. Box 8968 • Rocky Mount, NC 27804-6968

Phone: (252) 451-1031 • Email: