Fairwood Bible Institute
18 Fairwood Drive,  Dublin, New Hampshire 03444-8320  603-563-8492   FAX 603-563-8138

 Application for Admission
Send with $25 application fee and a photograph of yourself.

I. General Information

1. Legal Name__________________________________ Date of Birth__________________

   Name I go by____________________________ Place of Birth_______________________

   Social Security No.____________________  Driver's Lic. No._______________ State_____

2. Home address: ____________________________________________________________

   City____________________________ State_______ Zip__________ Telephone___-___-____

3. Sex___   Race___   Height_______   Weight_______   Citizenship_____________________

4. Status:  __single   __engaged   __married   __widowed   __separated   __divorced

II. Personal History
1. Parent(s) or Guardian: 

   Address________________________________ State____  Zip________  Tel.___-___-_____

2. Parents are:    __married    __divorced    __father deceased __mother deceased

   Father's Name __________________________ Mother's Name_______________________

3.  Check Appropriate box:
[ ]yes  [ ]no   Are your parents opposed to your decision to attend Fairwood Bible Institute?
[ ]yes  [ ]no   Have you any significant physical or learning impairment?
[ ]yes  [ ]no   Have you ever been treated for any nervous, mental, or emotional disorder?

[ ]yes  [ ]no   Have you ever used illegal or dangerous drugs?
[ ]yes  [ ]no   Do you in any way use alcoholic beverages?
[ ]yes  [ ]no   Do you use tobacco in any form?
[ ]yes  [ ]no   Do you currently have financial obligations?
[ ]yes  [ ]no   Were you ever expelled, dropped, or suspended by any school or college?
[ ]yes  [ ]no   Are you or have you ever been under the supervision of a parole officer or court?
[ ]yes  [ ]no   Have you ever been arrested for any reason other than a minor traffic violation?
[ ]yes  [ ]no   Do you have any disagreement with the Doctrinal Position (page 7 in handbook)?
If any answer is yes, please give complete details on a separate sheet of paper.

4. Write a brief autobiography (1-2 pages) mentioning your conversion, baptism, high points of your Christian experience, family background and anything else that might have a bearing on your attending Fairwood Bible Institute.  This could include your standard of conduct and personal convictions toward chastity, parental authority, inspiration of scripture, worldly entertainment, alcohol, drugs, etc. (Use a separate piece of paper.)

III. Christian Experience
1. Church Affiliation_____________________________________________________________

   Address_______________________________ City_____________ State____ Zip________
   Your Average Attendance:   __twice a week   __weekly   __monthly   __yearly

2. Has there ever been a time in your life when you actually accepted Jesus as your Savior? ___
   Give a brief description of circumstances, date, place, who assisted, Bible verses used, and so forth. _____________________________________________________________________________


3. If you were to die today, and God should ask you why He should let you into heaven, what would you say? ___________________________________________________________________________


 5. Write a brief statement of purpose (1/2 page) on why you desire to attend Fairwood Bible Institute.  What do you hope to receive?  What are your goals? You could also include how you heard of Fairwood, how long you plan to attend, or what made you decide to enroll. (use a separate piece of paper or blank portion of application form.)

IV. References:
(Please list three references below.  Send a recommendation form to two of the following of the three. Ask them to send it directly to Fairwood Bible Institute Adm., PO Box 445, Dublin, NH 03444)

1. Pastor: Name____________________________ Church____________________________

   Address__________________________ City________ State___ Zip_____ Phone________

2.  Name____________________________________________________

   Address_______________________ City________ State_____ Zip_____ Phone_________

3.  Name____________________________________________________

   Address_______________________ City________ State_____ Zip_____ Phone_________

V. Health Information:

1. Do you have any health condition or physical handicap which requires special attention?_____
   If yes, explain

2. Do you take any medication on a regular basis?____ If yes, what?_____________________

VI. Education:
Circle the year completed: High School 9 10 11 12 College 1 2 3 4 Post Grad. Masters  Doctoral

1. High School_________________________ Date Graduate(d)______ Date Withdrew_____
  Address__________________________________________________ Phone ___-____-_____

2. Name (schools since High School)  Date entered  Date withdrew     Date Graduated   Degree



3. When would you like to attend Fairwood?   ___as soon as accepted   ___Fall term 20__   Winter term 20___   by (date)____________

VII. Commitment
Please read the following statement carefully.  Your signature below certifies your acceptance of and agreement with all three.

1. I give my permission for any of my records be reviewed for the purpose of determining my acceptance at Fairwood Bible Institute.  This could include school records, police/court records, financial records, etc.

2. I have read the student rules in the handbook and am willing to accept the standards, rules and regulations of Fairwood Bible Institute.  

3. I certify that, to the best of my knowledge, the information given on this application is complete and accurate.

Signed______________________________________________________  Date_____________

I have read or am familiar with the standards, rules and regulations of Fairwood Bible Institute and will support my son/daughter in his/her commitment to abide by them.

 Signed __________________________________________________Date________________
            (Parent or Guardian)