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Name:
(Last) (First) (Middle)
Address:
(Street) (City) (State) (Zip)
Phone (Home) Phone: (Work) (Cellular #)
E-Mail Address: Fax Number:
Sex: Male Female Race: Date of Birth: U.S. Citizen: Yes No
Marital Status: Single Married Divorced Widowed
In Case of Emergency Contact: Phone:
Name of Church: Address:
SPIRITUAL INFORMATION
Yes No Do you believe the Bible is the inspired Word of God, and the infallible guide in matters pertaining to conduct and
doctrine? Do you believe in the Holy Godhead, manifested in 3 persons: Father, Son and the Holy Spirit? Do you believe
in the deity of the Lord Jesus Christ: that He is God made flesh and the only Mediator between God and Man?
If you answered No to any of the above questions, please explain.
RICHMOND CHRISTIAN CENTER BIBLE INSTITUTE CLASS SCHEDULE
(Check One) - 1st Year or 2nd Year
Indicate courses below for Semester I Indicate courses below for Semester II
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
I am aware that I must have good moral conduct to be considered a new student in RCCBI. By my signature, I affirm that my conduct and manner
of living remain in compliance with the standards established by RCCBI.