LEADERSHIP PROGRAM APPLICATION FORM

Canadian Lutheran Bible Institute

IMPORTANT 1. All information requested must be provided. 2. Application fee: $50.00 to be included with the submission of this form. (Application fee is not refundable but will be applied as a tuition deposit upon acceptance). 3. Forward High School / College transcripts if applicant has taken any classes since last attending CLBI. SEND TO:

Place photo here

OFFICE OF ADMISSIONS Canadian Lutheran Bible Institute

4837 - 52A St. CAMROSE, AB CANADA T4V 1W5

Phone: (780) 672-4454 Fax: (780) 672-4455 E-mail: info@clbi.edu

1. GENERAL INFORMATION (please print) Full Name

Last Name First Name Middle Name(s)

Present Mailing Address

Street or Post Office Box City Prov/State Postal Code

E-mail Address Permanent Home Address

Street or Post Office Box City

Fax Number
Prov/State Postal Code

Telephone Number Gender: Male Female Engaged

Social Insurance/Security Number Citizenship: Canada Married Divorced USA Separated Other

Marital Status: Single

2. PERSONAL INFORMATION Date of Birth

Day/Month/Year

Place of Birth
City Prov./State

Home Church
Church Name Street or Post Office Box City Prov/State Postal Code

3. PERSONAL STATEMENT Please provide a brief summary of your Bible school experience(s) thus far. Indicate key areas of growth or healing that have taken place in your life. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Attach additional sheets as necessary.

Canadian Lutheran Bible Institute Student Application Form

4.

LIVING PREFERENCES

PLEASE NOTE: The following information is needed for roommate placements and will not be used in determining your acceptance to Bible school. Dorm living preferences: single room (extra $200/semester) double room (with a roommate of the same gender)

Room request: Option #1 : __________ Option #2 : __________ (it is not guaranteed that you will be given either of these rooms) During school, my tendency is to be in bed by __________ pm. I usually get up around __________ am. I generally need ____ hours of sleep per night to function properly the next day. For each of the following, circle the appropriate number on a scale of 1 to 5. Rank your tendency in maintaining room cleanliness (1 = very clean, 5 = extreme disarray) Rank your social tendency (1 = extreme introvert/private, 5 = extreme extrovert/outgoing) Rank your tendency in responding to conflict (1 = strong-willed, 5 = flexible) Rank your tendency in completing assignments (1 = the same evening as assigned, 5 = all night just before the due date) 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

5. OTHER INFORMATION Do you have employment secured for the months before courses at CLBI will begin? Type of work _________________________________ How will you manage your financial obligations at CLBI? _________________________________________________ _________________________________________________________________________________________________ Do you plan to provide money through self-employment or savings to pay for CLBI costs? Do you intend to receive financial help from a parent or guardian? Will you be applying for Canadian or U.S. student loan programs? _____ YES _____ NO _____ YES _____ NO _____ YES _____ NO _____ YES _____ NO

Will a parent, guardian or sponsor (e.g. Church) assume financial responsibility for you if necessary? _____ YES _____ NO If 'YES,' signature of parent, guardian or sponsor must be supplied: ______________________ Date signed: ___________ Address ___________________________________________________________________________________________
Street or Post Office Box City Prov/State Postal Code

Canadian Lutheran Bible Institute Student Application Form

6. PERSONAL REFLECTIONS Address each of the following points on separate pages. Use as many pages as you require. i) ii) iii) iv) v) vi) vii) viii) ix) x) If you could re-live your first year of Bible school, what would you do differently? Explain the way you intend to apply the Christian leadership skills that you will gain through the CLBI program in your future endeavours. Currently, what do you foresee as a possible vocation? What area of Christian ministry is of greatest interest to you? Describe the specific involvement and contributions you would be most excited about making as a secondyear student at CLBI. Identify one area that you consider a personal area of strength that you desire to further develop. Describe one area that you foresee may be a hurdle to overcome as you take a role in leadership on campus. In teamwork situations, what roles do you often assume? (i.e. Spokesperson, organizer, mediator, labourer, encourager, etc.) Tell about two different situations in the past where you assumed two different roles (at CLBI or elsewhere). Project what you might do and specifically how your faith would be affected if you were not accepted to be a part of the Leadership Program at CLBI.

Attach additional sheets.

I hereby make application to attend Canadian Lutheran Bible Institutes second year Christian Leadership Program. I agree, that if I am accepted, I will abide by all the rules and regulations of the school and will commit myself fully to its program of studies and service and to the pursuit of becoming a servant leader following the example of Christ Jesus. Signature of Applicant ____________________________________ I intend to begin in the fall semester of _________________
year

Date of Application ____________________