Name: Have you received Jesus Christ as Lord & Saviour? When? Phone H: ( ) C: ( ) . Parents/Guardian Phone ( City Prov Postal Code

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1 Office Use: Rec d Ackn d Ref Reg. Fee Accepted NIPAWIN BIBLE COLLEGE Application For Admission I am applying to come (choose one): Recent Head-and-Shoulders Photo of Applicant! September 20! January 20! Other Are you currently applying at other institutions as well?! No! Yes Which ones? Housing Preference! Dorm! On-Campus Rental Housing! Off-Campus BASIC INFORMATION Name: Given Name Middle Name(s) Family Name Nickname/name used (if different from formal name)! Female! Male Have you received Jesus Christ as Lord & Saviour? When? S.I.N. # Age Birthdate (M/D/Y) / / Address City Prov/St Postal Code/Zip Country Phone H: ( ) C: ( ) Parents/Guardian Phone ( ) Address City Prov Postal Code Marital Status:! Single! Married! Divorced! Other (Complete below as applicable) Name of Spouse Children s Name and Ages (1) age (2) age (3) age (4) age (5) age CHURCH INFORMATION Name of church you currently attend Length of time attending (years) Are you a member? Address Phone ( ) Denomination Pastor/Youth Pastor

2 EDUCATION INFORMATION Last high school attended Province Check all that apply:! I graduated from High School in (yr)! I am in grade! I was in a modified program! I did not graduate, indicate highest grade completed We require an official transcript. Request it at your High School, but do not wait for it in order to apply. List educational institutions attended since high school: School Years Attended School Years Attended Have you experienced any learning difficulties/disabilities that may affect your studies at NBC?! Yes! No If Yes, please describe those difficulties/disabilities. REGISTRATION INFORMATION Indicate the academic program in which you are most interested: Bachelor of Arts (4-year): Biblical Studies! Leadership/Management! Pastoral Ministry! Youth Ministry! Bachelor of Christian Ministry (3-year): General Studies! Missions! Christian Ministry Diploma: (2-year)! Foundations For Life Certificate (1-year)! MEDICAL INFORMATION List any medications you must take on a regular basis Have you ever suffered from or received treatment for a mental disorder?! No! Yes, explain Check any of the following you have had and give an approximate date:! ADD, ADHD! Asthma! Diabetes! Epilepsy! Fainting! Headaches! Heart Problems! Hepatitis! Measles! Mononucleosis! Mumps! Polio! Rheumatic Fever! Small Pox! STDs! Tuberculosis! Typhoid! Other! Anxiety Disorder! Eating Disorder! Social Difficulties! Clinical Depression! Allergies - specify Provincial Health Services Number Has a doctor ever required you to be on a special diet?! No! Yes If yes, please provide details NOTE: The school cannot provide special diets for any student without an official medical request for such. In such a case, a $ fee per semester will be charged to the student s account.

3 ENROLLMENT INFORMATION How did you find out about NBC? List any relatives who attended NBC (name and relationship) What or who were the most influential factors/people that influenced your decision to apply to Nipawin Bible College? FINANCIAL INFORMATION How do you expect to meet your financial obligations at NBC? How much will you have on hand toward your schooling? Are you currently in debt?! No! Yes If yes, please explain Have you applied or do you plan to apply for any scholarships or student loans?! Scholarships For more information on available financial assistance, go to Student Loan BACKGROUND INFORMATION List any interests or hobbies you enjoy What type of music do you enjoy? List favorite groups/artists. What types of books do you enjoy? Describe your musical ability (instruments, training, experience, etc.) Describe your athletic/sports involvement (e.g. sports played, level of training experience, etc.) Indicate employment/business experience List any other skills/experience (e.g. photography, website design, IT, etc.) Have you used any of the following: (If yes indicate how recently in the blank.) Intoxicating Drinks! No! Yes, year Tobacco! No! Yes, year Non-medical drugs! No! Yes, year (If you checked yes to any of the above, please provide a note of explanation.) Have you ever been convicted of a criminal offence?! No! Yes (If Yes, please include a note of explanation) In order for students to participate in the Student Ministry program while studying at NBC we require a Vulnerable Sector check from the RCMP. Visit your local detachment to complete the form and background check.

4 REFERENCES Please list the names and addresses of the three individuals who will be filling out the character reference forms on the following pages. These should be people who know you best and are not relatives. You should supply them with a stamped envelope and ask that they mail us the completed form within one week of when you send NBC your application form. You are required to complete the top section for each form and sign the waiver. Pastor Phone ( ) Address City Prov Postal Code Christian Friend Phone ( ) Address City Prov Postal Code Employer/Teacher Phone ( ) Address City Prov Postal Code Personal Profile Please give a brief account of the following on a separate paper (8 1 2 x 11). Early years and schooling Home environment, including occupation of parents Conversion experience and how Jesus Christ became personal to you Involvement in the church and any practical Christian work Your purpose and goals in attending Nipawin Bible College Declaration: I declare that the above are answered fully and accurately, to the best of my knowledge and ability. If I am accepted as a student at Nipawin Bible College I agree to abide by all the regulations of the school. I also grant NBC permission and access to use the information supplied by my personal references in processing this application. In addition, I understand that any and all documents that are submitted to NBC as part of this application process become the property of NBC and I will not be able to obtain either the originals or copies of those documents from NBC. Signature of Applicant Date Pr Checklist (before you are accepted) :! Completed application form! A recent picture (e.g. small school photo)! Personal background details (Personal Profile) on a separate sheet of paper! Transcript (or arrangements made)! Application fee $50 ($75 after Aug. 15) (Must accompany application)! 3 Reference Forms - received by NBC! Local (Applicant s Home Detachment) RCMP Vulnerable Sector check completed no more than 3 months prior to enrollment Mail To: Nipawin Bible College Box 1986 Nipawin, SK S0E 1E0 If you have any questions, please contact us: ph fax info@nipawin.org

5 Nipawin Bible College Applicant Reference Form & Character Profile Assessment Pastor s Copy Waiver Statement (To be completed by the applicant) Applicant s Name: Mailing Address: I authorize the release of the disclosed information by the person completing this character reference form for the consideration of the applicant. I waive any right or privilege to inspect or challenge the contents of this form. I understand that the information will be held in confidence by Nipawin Bible College and will not be released to anyone (other than employees, agents, representatives, and/or professional advisors of Nipawin Bible College) without the permission of the person giving such character reference or in the absence of a Court Order, Subpoena, or laws requiring the disclosure of such information. signature of applicant date Phone: ( ) signature of parent/guardian if applicant is under 18 date The individual above has applied for studies at Nipawin Bible College. Please complete the following character reference to the best of your ability. All information will be kept in confidence by the school. An addressed, stamped envelope should be provided by the applicant for this form to be returned to Nipawin Bible College. Under no circumstances should it be returned to the applicant. * Please keep in mind that the application cannot be processed until reference forms are received. 1. In what capacity have you known the applicant? Pastor Friend Employer Teacher Other 2. Approximately how long have you known the applicant? years 3. How well do you know the applicant? Check one: ( ) Not too well ( ) Casually ( ) Quite well ( ) Very well 4. Please give what information you can regarding the applicant s family life. 5. To your knowledge, has the applicant acknowledged Jesus Christ as their Saviour? Yes (If so, when? ) No Uncertain 6. To what extent does the applicant attend the services/activities of his/her church? (check one): ( ) Irregular in attendance ( ) Seldom participates ( ) Fairly active ( ) Very active 7. What personal strengths have you observed? 8. Have you ever had occasion to question his/her morals? Yes No If yes, please explain: 9. How does the applicant respond to authority?

6 Check any traits that characterize the applicant: Impulsive High energy level Shy, reserved Sexist Friendly Self starter Follower Often needs emotional support Critical of Others Good sense of humour Quick-tempered Uses Inappropriate humor Mature Domineering Low energy level Has respect for others Flexible Moody Often anxious Shares faith naturally Argumentative Low self-esteem Lazy Leader Extrovert Sensitive and caring Constantly complaining Fun Introvert Happy Easily embarrassed Prejudiced Indecisive Pleasant to be with Easily discouraged 1. Peer Relationships Generally avoided Slow to make friends Makes friends easily Very popular 2. Relational Style Loner Reserved Outgoing, friendly Overbearing 3. Relationship w/opposite Sex Relates well / at ease Considerate but awkward Insensitive/insecure 4. Communication Skills Clear, confident in communication ability to communicate Unable to communicate clearly 5. Leadership Strong leadership abilities Assumes occasional leadership Tries, but struggles in leadership Usually a follower 6. Response to Stress/Pressure Copes well Adapts slowly Becomes overly critical of others Dominates situation or people Withdraws socially or emotionally 7. Self Assurance Very Confident confidence Needs encouragement Insecure 8. Spiritual Life Consistently positive testimony Shows good growth toward maturity Little evidence No interest in spiritual growth 9. Initiative Very good Succeeds if well directed Requires much oversight Please indicate your recommendation of the applicant to attend Nipawin Bible College (check one box): Highly recommended Recommended with reservation (please explain below) Not recommended (please explain below) I am willing to be contacted by NBC as a follow-up to this reference form. Name (print): Phone #: Signature: Date: This form is not to be returned to the applicant. Please mail directly to Nipawin Bible College. Box 1986 Nipawin SK S0E 1E0 ph fax info@nipawin.org

7 Nipawin Bible College Applicant Reference Form & Character Profile Assessment Friend s Copy Waiver Statement (To be completed by the applicant) Applicant s Name: Mailing Address: I authorize the release of the disclosed information by the person completing this character reference form for the consideration of the applicant. I waive any right or privilege to inspect or challenge the contents of this form. I understand that the information will be held in confidence by Nipawin Bible College and will not be released to anyone (other than employees, agents, representatives, and/or professional advisors of Nipawin Bible College) without the permission of the person giving such character reference or in the absence of a Court Order, Subpoena, or laws requiring the disclosure of such information. signature of applicant date Phone: ( ) signature of parent/guardian if applicant is under 18 date The individual above has applied for studies at Nipawin Bible College. Please complete the following character reference to the best of your ability. All information will be kept in confidence by the school. An addressed, stamped envelope should be provided by the applicant for this form to be returned to Nipawin Bible College. Under no circumstances should it be returned to the applicant. * Please keep in mind that the application cannot be processed until reference forms are received. 1. In what capacity have you known the applicant? Pastor Friend Employer Teacher Other 2. Approximately how long have you known the applicant? years 3. How well do you know the applicant? Check one: ( ) Not too well ( ) Casually ( ) Quite well ( ) Very well 4. Please give what information you can regarding the applicant s family life. 5. To your knowledge, has the applicant acknowledged Jesus Christ as their Saviour? Yes (If so, when? ) No Uncertain 6. To what extent does the applicant attend the services/activities of his/her church? (check one): ( ) Irregular in attendance ( ) Seldom participates ( ) Fairly active ( ) Very active 7. What personal strengths have you observed? 8. Have you ever had occasion to question his/her morals? Yes No If yes, please explain: 9. How does the applicant respond to authority?

8 Check any traits that characterize the applicant: Impulsive High energy level Shy, reserved Sexist Friendly Self starter Follower Often needs emotional support Critical of Others Good sense of humour Quick-tempered Uses Inappropriate humor Mature Domineering Low energy level Has respect for others Flexible Moody Often anxious Shares faith naturally Argumentative Low self-esteem Lazy Leader Extrovert Sensitive and caring Constantly complaining Fun Introvert Happy Easily embarrassed Prejudiced Indecisive Pleasant to be with Easily discouraged 1. Peer Relationships Generally avoided Slow to make friends Makes friends easily Very popular 2. Relational Style Loner Reserved Outgoing, friendly Overbearing 3. Relationship w/opposite Sex Relates well / at ease Considerate but awkward Insensitive/insecure 4. Communication Skills Clear, confident in communication ability to communicate Unable to communicate clearly 5. Leadership Strong leadership abilities Assumes occasional leadership Tries, but struggles in leadership Usually a follower 6. Response to Stress/Pressure Copes well Adapts slowly Becomes overly critical of others Dominates situation or people Withdraws socially or emotionally 7. Self Assurance Very Confident confidence Needs encouragement Insecure 8. Spiritual Life Consistently positive testimony Shows good growth toward maturity Little evidence No interest in spiritual growth 9. Initiative Very good Succeeds if well directed Requires much oversight Please indicate your recommendation of the applicant to attend Nipawin Bible College (check one box): Highly recommended Recommended with reservation (please explain below) Not recommended (please explain below) I am willing to be contacted by NBC as a follow-up to this reference form. Name (print): Phone #: Signature: Date: This form is not to be returned to the applicant. Please mail directly to Nipawin Bible College. Box 1986 Nipawin SK S0E 1E0 ph fax info@nipawin.org

9 " Nipawin Bible College Applicant Reference Form & Character Profile Assessment Employer/Teacher Copy Waiver Statement (To be completed by the applicant) Applicant s Name: Mailing Address: I authorize the release of the disclosed information by the person completing this character reference form for the consideration of the applicant. I waive any right or privilege to inspect or challenge the contents of this form. I understand that the information will be held in confidence by Nipawin Bible College and will not be released to anyone (other than employees, agents, representatives, and/or professional advisors of Nipawin Bible College) without the permission of the person giving such character reference or in the absence of a Court Order, Subpoena, or laws requiring the disclosure of such information. signature of applicant date Phone: ( ) The individual above has applied for studies at Nipawin Bible College. Please complete the following character reference to the best of your ability. All information will be kept in confidence by the school. An addressed, stamped envelope should be provided by the applicant for this form to be returned to Nipawin Bible College. Under no circumstances should it be returned to the applicant. * Please keep in mind that the application cannot be processed until reference forms are received. 1. In what capacity have you known the applicant? Pastor Friend Employer Teacher Other 2. Approximately how long have you known the applicant? years 3. How well do you know the applicant? Check one: ( ) Not too well ( ) Casually ( ) Quite well ( ) Very well 4. Please give what information you can regarding the applicant s family life. 5. To your knowledge, has the applicant acknowledged Jesus Christ as their Saviour? Yes (If so, when? ) No Uncertain 6. To what extent does the applicant attend the services/activities of his/her church? (check one): ( ) Irregular in attendance ( ) Seldom participates ( ) Fairly active ( ) Very active 7. What personal strengths have you observed? 8. Have you ever had occasion to question his/her morals? Yes No If yes, please explain: 9. How does the applicant respond to authority?

10 Check any traits that characterize the applicant: Impulsive High energy level Shy, reserved Sexist Friendly Self starter Follower Often needs emotional support Critical of Others Good sense of humour Quick-tempered Uses Inappropriate humor Mature Domineering Low energy level Has respect for others Flexible Moody Often anxious Shares faith naturally Argumentative Low self-esteem Lazy Leader Extrovert Sensitive and caring Constantly complaining Fun Introvert Happy Easily embarrassed Prejudiced Indecisive Pleasant to be with Easily discouraged 1. Peer Relationships Generally avoided Slow to make friends Makes friends easily Very popular 2. Relational Style Loner Reserved Outgoing, friendly Overbearing 3. Relationship w/opposite Sex Relates well / at ease Considerate but awkward Insensitive/insecure 4. Communication Skills Clear, confident in communication ability to communicate Unable to communicate clearly 5. Leadership Strong leadership abilities Assumes occasional leadership Tries, but struggles in leadership Usually a follower 6. Response to Stress/Pressure Copes well Adapts slowly Becomes overly critical of others Dominates situation or people Withdraws socially or emotionally 7. Self Assurance Very Confident confidence Needs encouragement Insecure 8. Spiritual Life Consistently positive testimony Shows good growth toward maturity Little evidence No interest in spiritual growth 9. Initiative Very good Succeeds if well directed Requires much oversight Please indicate your recommendation of the applicant to attend Nipawin Bible College (check one box): Highly recommended Recommended with reservation (please explain below) Not recommended (please explain below) I am willing to be contacted by NBC as a follow-up to this reference form. Name (print): Phone #: Signature: Date: This form is not to be returned to the applicant. Please mail directly to Nipawin Bible College. Box 1986 Nipawin SK S0E 1E0 ph fax info@nipawin.org