New Student Application Packet
This application is for NEW Students (those who have never attended
a CCBC campus). If you have attended CCBC Murrieta or any other CCBC
extension
campus, please only complete the CONTINUING STUDENT APPLICATION PACKET.
Name: ____________________________________________
Email Address: ____________________________________
Checklist
The following items should be enclosed with this application:
Completed Application Form (attached)—signed and dated
3 Reference Forms (one must be pastoral). Reference forms may either be submitted
with this packet in sealed envelopes or they may be mailed directly to CCBC Italy by the
referrer.
Passport style photo (affixed above)
€20 ($30 if submitted in U.S. funds)—non-refundable. If paying by U.S.check
submit $45 (to include $15 foreign check fee) and make check payable to:
CALVARY CHAPEL
A photocopy of your high school diploma or GED certificate, and, if applicable, your
college transcripts.
Send to:
Calvary Chapel Bible College Italy
Via J. Riccati 17
31031 Caerano S. Marco (TV)
Italia
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Application packet received: _______________
Reply email sent: _______________________ Fees paid:
___________________________________
Affix passport style
photo here
New Student Application for Admission
Biographical Information
Last name: First name Middle name:
Address:
City: State: Zip/Postal Code: Country:
Home Phone: Mobile Phone:
Email Address SSN (U.S. students only):
Date of Birth (dd/mm/yyyy): Sex: Occupation:
Place of Birth (city, state, country): Citizenship:
Marital Status: Single □ Married □ Divorced □ Widowed □ Currently in Relationship □
General Information
Have you ever attended a CCBC campus? Yes No If yes, how many semesters have you attended? Have you ever been denied admission to a CCBC campus? Yes No If so, explain:
Have you ever been expelled from a CCBC campus? Yes No If so, explain
For which semester are you applying? Fall Spring 2015 2016 Do you intend to complete the entire program offered by CCBC? Yes No Unsure
Are you aware that CCBC Italy is a “campus plant” and are you willing to be a part of challenges associated with a campus on the mission field? Yes No
Education
Please list all schools attended from high school to present:
Name of School Dates of Attendance Degree/Diploma Earned
Major/Minor
Emergency Contact (who may we contact in case of an emergency?)
Full Name:
Relationship: Telephone:
Address:
Email:
_______________________________ ____
Medical Information
Are you in good health? Yes No When was your last complete physical exam? Do you take any medications? If yes, please explain:
Have you had any major illnesses? If yes, please explain:
Do you have any physical disabilities?
Have you been, or are you presently under psychiatric or psychological care, or have you been in counseling or psychotherapy? If yes, explain:
Personal Information
Are you a smoker? If yes, explain:
Do you drink alcoholic beverages? If yes, explain:
Have you, or are you currently, using illegal drugs? If yes, explain: Have you ever been convicted of a felony? If yes, explain:
Do you have any history of violence or abuse towards others? If yes, explain:
Does your life currently conform to Biblical standards of morality? If no, explain: Is there habitual sin in your life that affects your walk with God? If yes, explain:
Do you have trouble getting along or often have conflict in relationships? If yes, explain: Have you ever been involved in any non-Christian cults or occult activities? If yes, explain:
Spiritual Life Profile (please answer the following questions on a separate piece of
paper)
1. Tell us about your salvation experience. How did you become a Christian?
2. Please describe your current relationship with the Lord in terms of your devotional and prayer life.
3. Where do you attend Church? How long have you been attending? What is your current church involvement? 4. Why do you desire to attend CCBC Italy, and how do you see it enhancing your present spiritual life and future ministry plans?
Please list the three Christian preachers/teachers, if any, who have most influenced your life 1.
2.
3.
Please list three Christian books, if any, which have most influenced your life. Provide both title and author. 1.
2. 3.
Personal Life Profile (please answer the following questions on a separate piece of
paper)
1. How would you describe your a) personality, and b) your relationships with others?
2. What do you consider to be your a) personal strengths, b) weaknesses, and c) spiritual gifts?
Please list and describe them.
3. What are your talents, hobbies and interests?
Statement of Faith (please answer the following questions on a separate piece of paper)
Write a brief statement describing your belief on the following:
1) The Bible 2) God 3) Jesus Christ 4) Holy Spirit 5) Sin 6) Salvation 7) Baptism with the
Holy Spirit
8) Eschatology (End Time Events) 9) The Rapture 10) Eternal Security
Practical Christian Ministry
All students must enroll in M199, a Practical Christian Ministry course designed to teach the
student how to serve the needs of the body of Christ. Each student serves approximately five
hours each week in a designated area of service. Additionally, students are periodically asked to
serve in special capacities to minister to others. By submitting this application you agree to
enrolling and participating in the Practical Christian Ministry course.
Financial Responsibility
I understand that the application fee and 400 EUROS deposit are non-refundable
and that the remaining tuition is due and payable either prior or during
registration. I have read and understand the CCBC Italy refund policy as stated
on the Schedule of Fees.
I hereby apply to Calvary Chapel Bible College Italy. I will observe all
regulations and uphold the standards of the college.
Printed Name:
Signed Name:
Date:
Calvary Chapel Bible College Italy does not discriminate on the basis of
race, sex, ethnic background, native language, nationality or physical
disability. CCBC Italy is a ministry of Calvary Chapel Montebelluna, Italy,
and is an extension campus of Calvary Chapel Bible College Murrieta,
California.
NEW STUDENT REFERENCE FORM
Applicant’s Last Name: First Name:
The Family Education Rights and Privacy Act of 1974 permits students the right
to inspect their files. Because of the importance of preserving the confidentiality of a
reference, the Act permits an applicant to waive his right of access to the reference. By
signing below, the applicant willingly waives their right of access to see this reference,
knowing that this waiver is NOT required as a condition of admission.
Applicant’s Signature:
To the Person Writing the Reference: The above-mentioned applicant has applied
for acceptance as a student at Calvary Chapel Bible College Italy and has named you
as a reference. Your reference contributes to the decision made by our staff regarding
this applicant. Therefore, please be thorough and timely in your response.
1. How long have you known the applicant?
2. In what capacity have you known the applicant?
3. How long has the applicant been an active Christian?
4. Do you have any questions about the applicant’s commitment to Jesus Christ?
5. Describe the evidences you see in the applicant’s life that demonstrate his or her
commitment to follow Christ:
6. Please circle the appropriate number on the following questions. Use a “?” if you feel
your knowledge of the applicant is insufficient in that particular area.
Responsibility – Ability to faithfully assume and carry out duties or obligations.
1 2 3 4 5 6 7
Not responsible Somewhat responsible Responsible
Adaptability – Ability to adjust to changes in circumstances.
1 2 3 4 5 6 7
Difficult Moderate ability
Adapts well
Cooperation/Teamwork – Relates well to others in a living or work setting.
1 2 3 4 5 6 7
Unable to cooperate Reasonably cooperative Cooperative
Communication – Able to express thoughts, feelings and ideas with others.
1 2 3 4 5 6 7
Poor communication Average Communicates
well
Spiritual Maturity – Demonstrates holiness, maturity and consistency.
1 2 3 4 5 6 7
Immature Growing
Consistent growth Church involvement
1 2 3 4 5 6 7
Infrequent Active Heavily involved
Emotional Stability
1 2 3 4 5 6 7
Difficult Average Very
stable
Personal recommendation
1 2 3 4 5 6 7
Do not recommend Recommend Highly
recommend