Please fill out all of the information as detailed as possible.

Basic Information

Your Name*

Your Address*

Date of Birth*
- -

Marital Status*
Single Married Divorced Widowed 

Contact Information

Home Phone*:     - -
Cell Phone:           - -
Work Phone:         - -



Health Information

Are you currently on any medications?
 Yes No

Do you have any food allergies?

Educational History

Highest level completed.

College Experience:

Degree Earned:
     Year of Graduation:
Do we have permission to request a copy of your transcripts?
 Yes No

Criminal Record

Have you ever been convicted of a felony?
 Yes No
Have you ever used illegal drugs\narcotics?
 Yes No
Have you ever been accused of sexual abuse?
 Yes No

Salvation Testimony

Please tell us your salvation testimony:

Have you been baptized?
 Yes No

Are you a member in good standing of a local church?
 Yes No

If not, please explain why?

What church are you a member of?

When did you become a member of your church?
- -

How do you serve your local church?

Does your pastor know of your desire to attend The Log College?
 Yes No

What does he think of this desire?

What is the church’s website address?

Are you in agreement with our basic doctrinal distinctives?
 Yes No

Do you hold to the doctrines of grace (TULIP)?
 Yes No

If not why not?