Student Application Form for Play School - PDF

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					                                                                                  CAPERNWRAY HARBOUR
                                                                            BIBLE SCHOOL
                                                                                        Application Form
                                                                                              PLEASE PRINT CLEARLY

    BIBLE SCHOOL YEAR
    What year are you applying for?                                                                            September 20………. to May 20………


     PERSONAL INFORMATION                                                                                                                                            PASSPORT PHOTOS
     Last Name                                                                                                                                                               (for display purposes)

     First name                                                             Salutation

     Middle name                                                                                                                                                          Affix or enclose 2
                                                                                                                                                                           54mm X 45mm
     Gender                           ……….Male……….Female                                                                                                                PASSPORT PHOTOS
                                                                                                                                                                           with application
     Date of Birth                    ………./day………./month………./year

     Citizenship

     ADDRESS / CONTACT INFORMATION
     Home Street / Mailing Address

     City

     Prov / State
                                                                                                                                                                 EMERGENCY
                                                                                                                                                                 CONTACT
     Postal Code / Zip                                                                                                                                           For notification in the event of an
                                                                                                                                                                 emergency
     Country
                                                                                                                                                                 Name
     Telephone

     Email Address                                                                                                                                               Relationship

     Profession, Training,                                                                                                                                       Contact Phone Number
     or Last Grade/Degree Completed

     Have you applied to another Bible School or College for this period                                                                                         OFFICE USE ONLY
     of study? If so, please specify.                                                                                                                            Date Received


     How did you become aware of Capernwray Harbour?                                                                                                             Application Fee


     Have you had a close relative attend a Torchbearer Bible School?                                                                                            Passport Photo
     If so, please specify name & Bible School attended.

PRIVACY POLICY: Capernwray Harbour Bible Centre is committed to protecting the privacy, confidentiality and security of student, guest and staff personal information and has a Privacy Policy for these. The Policy can be found at our
                       website www.capernwray.ca (under TAB “More Info”) or can be obtained by contacting our Privacy Officer at 250-246-9440 (tel), 250-246-3201 (fax) or dsnyder@capernwray.ca.
RELATIONSHIPS
Which of the following applies to you?
……….single ……….engaged ……….married ……….widowed ……….divorced ……….single parent

If engaged, do you have a date set for your wedding? If yes, when?

If married, give name of spouse

Do you have a friend or relative applying as well? If yes, please give their name(s)

What is their relationship to you?

HEALTH & MEDICAL INFORMATION
If you answer ‘yes’ to any of the following ten questions, please provide details on a separate sheet to be
enclosed with this application. *You may be required to provide a medical doctor’s report.

1. Do you suffer from any disability, which would limit you participating in practical duties?   ……….yes       ………no
2. Have you had a nervous or mental illness at any time?                                         ……….yes       ………no
3. Have you suffered from or had treatment for anorexia nervosa or bulimia?                      ……….yes       ………no
4. Do you have diabetes, epilepsy, blackouts or other diagnosed medical problems?                ……….yes       ………no
5. Do you require any regularly prescribed medication?                                           ……….yes       ………no
6. Do you require a special diet for medical reasons?                                            ……….yes       ………no
7. Do you have a learning disability?                                                            ……….yes       ………no
8. Have you used tobacco, alcohol or illegal drugs in the last year?                             ……….yes       ………no
9. Have you ever had treatment for alcoholism or drug addiction?                                 ……….yes       ………no
10. Have you had surgery within the past six months, or extended medical care?                   ……….yes       ………no

Name of current medical plan

Medical Plan number (Canadians; please give Provincial Health Care Card Number)
All students are expected to provide their own medical coverage. An economical plan with adequate coverage
is available through Capernwray Harbour Bible Centre for students who do not have any medical coverage.

TALENTS, HOBBIES & WORK EXPERIENCE
Do you have any specific abilities or experience that could be useful for the practical running of the Bible
School? Eg. carpentry, plumbing, lifeguard etc.


What are your hobbies?


Do you play a musical instrument? If so, which one(s).


Have you any previous experience in outreach ministries involving singing, music or drama? If so, please detail.



In what Christian service have you been engaged?


Give the name, address & pastor’s name of the church you are currently attending?
CONDITIONS OF ENROLLMENT
TIMETABLE
• All students are expected to devote themselves unreservedly to their studies in lectures and study
periods, which are compulsory and to conform willingly and promptly to the programme throughout the day. Punctuality & cooperation are expected.
• All students attend local churches Sunday mornings and join together on Sunday evenings for worship.
• All students help in the daily domestic duties of the Bible School.
• All students are involved in regular outreach commitments.
STUDY OBLIGATIONS
• Students are expected to complete the Bible School year applied for, arriving on the first day of school and remaining through to the closing date.
• Permission must be obtained from the Assistant Director for students to be absent from lectures or for any overnight stays off campus apart from set
break dates.
APPEARANCE
• Clothing: Clean, neat and modest dress as worthy of a Christian who desires to glorify the Lord Jesus will be expected. Please show moderation
and modesty at all times, regardless of prevailing fashions in a permissive society.
• Ladies: Female students will be expected to wear dresses or skirts on Sundays to local church meetings, Sunday supper & Sunday evening
worship.
• Men: Male students will be expected to wear dress or semi-dress pants and an appropriate jacket or sweater, shirt & tie on Sundays to local church
meetings, Sunday supper & Sunday evening worship meetings.
• Ministry Teams: Same requirements as above.
• Piercings: No facial or body piercing. No earrings on male students.
• Hair: Hair is expected to be clean, tidy & well groomed. No extreme styles or colours.
STUDENT CONDUCT, LIFESTYLE & ADDICTIONS
• Students will give full cooperation to the staff & administration of Capernwray Harbour Bible Centre.
• Students are not allowed in or around the student accommodations of the other sex as these are considered bedroom areas.
• Curfew for students to be in their assigned accommodation will be 10:30 pm Saturday to Thursday with lights out at 11:00 pm. Curfew on Friday
nights will be at 12:00 am (or last ferry arrival) with lights out at 12:30 am.
• Pursuing exclusive, serious companionship with the other sex will not be promoted during the Bible School period.
• Students are to abstain from promoting and engaging in premarital or extra marital sexual involvement, pornographic involvement and homosexual
behaviour.
• The use of tobacco, alcoholic beverages and illegal drugs are strictly forbidden for legal, moral and spiritual reasons. It is expected that students
who indulge in these will quit prior to Bible School registration and abstain throughout the Bible School year. Pubs & bars are considered
inappropriate for Christian fellowship and are considered off limits for students.
• All students are expected to provide their own medical coverage during the Bible School period.
REFUND POLICY
Capernwray Harbour has a Refund Policy Guideline and each refund will be considered on an individual basis for a student who has withdrawn or
been expelled (for whatever reason). It will be fair to all parties and generous as is our usual practice.

ENROLLMENT AGREEMENT
I have answered all questions in this application form accurately and to the best of my knowledge. I have read
through, fully understand & agree to the above ‘Conditions of Enrollment’ and the Financial Payment Options sheet.
I agree that if I breach these requirements, the Bible School will have the right to suspend me or terminate this
agreement without notice. I agree to unreservedly carry out my studies & duties in accordance with this agreement
at all times to the best of my ability. I have also read through, fully understand & agree to the Bible School Privacy
Policy, found on Capernwray Harbour’s Web Site: www.capernwray.ca under the Tab “More Info”.



Printed name of applicant                                 Signature of Applicant                                     Date

APPLICATION INFORMATION CHECKLIST
All applicants, please CHECK the following:
       I have answered all questions in this application form
       I will mail or email the following items to supplement this application form:
          • A $40 CAD non-refundable application fee
          • Digital Photos sent to registrar@capernwray.ca (single, head and shoulders, 54mm X 45mm, colour)
          • Completed Financial Payment Options sheet
       I have read through the ‘Conditions of Enrollment’ & signed the ‘Enrollment Agreement’ above
       I will give one reference form to my minister and one to a non-relative who knows me well to fill out & return
       I will mail this completed application form with required enclosures to:
        Bible School Registrar
        Capernwray Harbour Bible Centre
        PO Box 1-10
        Thetis Island BC V0R 2Y0 Canada
CHRISTIAN EXPERIENCE
Give a brief account of your conversion and experience of the Lord Jesus Christ?




What are your reasons for applying to attend Bible School?




Have you been convicted of a crime requiring jail term? If so, please specify.




REFERENCES
Please provide the names & addresses of those who will be filling out a reference form for you.

• Pastor or Church Official Reference
Name

Address

• Friend or Associate Reference
Name

Address
                               CAPERNWRAY HARBOUR BIBLE CENTRE
                                            PO BOX 1-10
                                THETIS ISLAND BC V0R 2Y0 CANADA
               TEL: (250) 246-9440 FAX: (250) 246-3201 EMAIL: CHBC@CAPERNWRAY.CA
     M E M B E R               T O R C H B E A R E R S                       I N T E R N A T I O N A L
                                 BIBLE SCHOOL
                                   REFERENCE FORM
                                        PLEASE PRINT CLEARLY
INSTRUCTIONS TO STUDENT: Fill out your name and address and give one form to your minister and one to an
                         adult who is not a relative who knows you well.

Last Name                                                          First Name

Address                                                            City

Prov / State                                                       Country

REFERENCE: The applicant named above has indicated your willingness to be a reference for their Bible School
           application. We would appreciate you answering the following questions.

Length of relationship with applicant is:
                                     ……….less than 1 yr ……….1 – 2 yrs ………3 – 5 yrs ……….+ 5 yrs

How well do you know the applicant?
                                   ……….by name/sight ……….casually ……….fairly well ……….very close

How long has the applicant been a born-again Christian?


Please indicate the level of consistency in each of the following areas of the applicant’s life:
                                      Consistent         Frequent           Occasional             Seldom
Bible Study                           ……………              ……………              ……………                  ……………
Church Attendance                     ……………              ……………              ……………                  ……………
Church Service & Ministry             ……………              ……………              ……………                  ……………
Witnessing                            ……………              ……………              ……………                  ……………
Challenging others spiritually        ……………              ……………              ……………                  ……………

Is the applicant mature enough to adjust & live in a college community?
                                    ……….strongly agree ……….agree ……….disagree

Does the applicant use or indulge in the following:
                                     ……….tobacco ……….alcohol ………. illicit drugs ……….none to my knowledge

I believe the applicant shows particular ability in:


I have no reservations concerning the applicant’s honesty & integrity:
                                    ……….strongly agree ……….agree ……….disagree

I recommend the applicant for study at a Torchbearer Bible School:
                                    ……….unreservedly ………. with reservations ……….do not recommend

If you do not recommend, please comment:


          M E M B E R             T O R C H B E A R E R S                      I N T E R N A T I O N A L
 To your knowledge, has the applicant ever been:
 a) involved in the occult……….yes ……….no                                                      b) convicted of a crime requiring jail term……….yes ……….no

 In order to give us a better profile of the applicant as a person, please rate the applicant in each of the following by
 circling the number which best represents where the applicant fits on the scale:


 Self control                                     1           2                    3               4               5                6               7          8      9                              10                ?
                                                  very little                                                                                       extremely self-controlled
 Committed Believer                               1           2                    3               4               5                6               7          8      9                              10                ?
                                                  uncommitted                                                                                       highly committed
 Teachable                                        1           2                    3               4               5                6               7          8      9                              10                ?
                                                  rebellious                                                                                        supportive
 Home Background                                  1           2                    3               4               5                6               7          8      9                              10                ?
                                                  unsupportive                                                                                      supportive
 Personality                                      1           2                    3               4               5                6               7          8      9                              10                ?
                                                  withdrawn                                                                                         outgoing
 Relationships                                    1           2                    3               4               5                6               7          8      9                              10                ?
                                                  abrasive                                                                                          congenial
 Emotional Stability                              1           2                    3               4               5                6               7          8      9                              10                ?
                                                  unstable                                                                                          stable
 Initiative                                       1           2                    3               4               5                6               7          8      9                              10                ?
                                                  never initiates                                                                                   takes initiative
 Leadership                                       1           2                    3               4               5                6               7          8      9                              10                ?
                                                  never leads                                                                                       leader
 Dependability                                    1           2                    3               4               5                6               7          8      9                              10                ?
                                                  irresponsible                                                                                     extremely dependable
 Judgement                                        1           2                    3               4               5                6               7          8      9                              10                ?
                                                  poor                                                                                              very discerning


 Please add any further comments you feel would be helpful regarding the applicant:




 Name of Reference                                                                                                         Position

 Address                                                                                                                   City

 Prov / State                                                                                                              Postal Code / Zip

 Country                                                    Telephone                                                      Email

 Reference Signature                                                                                                       Date

 Please return the completed form to:                               Capernwray Harbour Bible Centre, PO Box 1-10, Thetis Island BC V0R 2Y0
                                                                    Canada, Phone: (250) 246-9440, Fax: (250) 246-3201
PRIVACY POLICY: Capernwray Harbour Bible Centre is committed to protecting the privacy, confidentiality and security of student, guest and staff personal information and has a Privacy Policy for these. The Policy
      can be found at our website www.capernwray.ca (under TAB “More Info”) or can be obtained by contacting our Privacy Officer at 250-246-9440 (tel), 250-246-3201 (fax) or dsnyder@capernwray.ca.



             M E M B E R                            T O R C H B E A R E R S                                                      I N T E R N A T I O N A L
                                 BIBLE SCHOOL
                                   REFERENCE FORM
                                        PLEASE PRINT CLEARLY
INSTRUCTIONS TO STUDENT: Fill out your name and address and give one form to your minister and one to an
                         adult who is not a relative who knows you well.

Last Name                                                          First Name

Address                                                            City

Prov / State                                                       Country

REFERENCE: The applicant named above has indicated your willingness to be a reference for their Bible School
           application. We would appreciate you answering the following questions.

Length of relationship with applicant is:
                                     ……….less than 1 yr ……….1 – 2 yrs ………3 – 5 yrs ……….+ 5 yrs

How well do you know the applicant?
                                   ……….by name/sight ……….casually ……….fairly well ……….very close

How long has the applicant been a born-again Christian?


Please indicate the level of consistency in each of the following areas of the applicant’s life:
                                      Consistent         Frequent           Occasional             Seldom
Bible Study                           ……………              ……………              ……………                  ……………
Church Attendance                     ……………              ……………              ……………                  ……………
Church Service & Ministry             ……………              ……………              ……………                  ……………
Witnessing                            ……………              ……………              ……………                  ……………
Challenging others spiritually        ……………              ……………              ……………                  ……………

Is the applicant mature enough to adjust & live in a college community?
                                    ……….strongly agree ……….agree ……….disagree

Does the applicant use or indulge in the following:
                                     ……….tobacco ……….alcohol ………. illicit drugs ……….none to my knowledge

I believe the applicant shows particular ability in:


I have no reservations concerning the applicant’s honesty & integrity:
                                    ……….strongly agree ……….agree ……….disagree

I recommend the applicant for study at a Torchbearer Bible School:
                                    ……….unreservedly ………. with reservations ……….do not recommend

If you do not recommend, please comment:


          M E M B E R             T O R C H B E A R E R S                      I N T E R N A T I O N A L
 To your knowledge, has the applicant ever been:
 a) involved in the occult……….yes ……….no                                                      b) convicted of a crime requiring jail term……….yes ……….no

 In order to give us a better profile of the applicant as a person, please rate the applicant in each of the following by
 circling the number which best represents where the applicant fits on the scale:


 Self control                                     1           2                    3               4               5                6               7          8      9                              10                ?
                                                  very little                                                                                       extremely self-controlled
 Committed Believer                               1           2                    3               4               5                6               7          8      9                              10                ?
                                                  uncommitted                                                                                       highly committed
 Teachable                                        1           2                    3               4               5                6               7          8      9                              10                ?
                                                  rebellious                                                                                        supportive
 Home Background                                  1           2                    3               4               5                6               7          8      9                              10                ?
                                                  unsupportive                                                                                      supportive
 Personality                                      1           2                    3               4               5                6               7          8      9                              10                ?
                                                  withdrawn                                                                                         outgoing
 Relationships                                    1           2                    3               4               5                6               7          8      9                              10                ?
                                                  abrasive                                                                                          congenial
 Emotional Stability                              1           2                    3               4               5                6               7          8      9                              10                ?
                                                  unstable                                                                                          stable
 Initiative                                       1           2                    3               4               5                6               7          8      9                              10                ?
                                                  never initiates                                                                                   takes initiative
 Leadership                                       1           2                    3               4               5                6               7          8      9                              10                ?
                                                  never leads                                                                                       leader
 Dependability                                    1           2                    3               4               5                6               7          8      9                              10                ?
                                                  irresponsible                                                                                     extremely dependable
 Judgement                                        1           2                    3               4               5                6               7          8      9                              10                ?
                                                  poor                                                                                              very discerning


 Please add any further comments you feel would be helpful regarding the applicant:




 Name of Reference                                                                                                         Position

 Address                                                                                                                   City

 Prov / State                                                                                                              Postal Code / Zip

 Country                                                    Telephone                                                      Email

 Reference Signature                                                                                                       Date

 Please return the completed form to:                               Capernwray Harbour Bible Centre, PO Box 1-10, Thetis Island BC V0R 2Y0
                                                                    Canada, Phone: (250) 246-9440, Fax: (250) 246-3201
PRIVACY POLICY: Capernwray Harbour Bible Centre is committed to protecting the privacy, confidentiality and security of student, guest and staff personal information and has a Privacy Policy for these. The Policy
      can be found at our website www.capernwray.ca (under TAB “More Info”) or can be obtained by contacting our Privacy Officer at 250-246-9440 (tel), 250-246-3201 (fax) or dsnyder@capernwray.ca.



             M E M B E R                            T O R C H B E A R E R S                                                      I N T E R N A T I O N A L
                                                              BIBLE SCHOOL
                                              Financial payment options
                                                                   PLEASE PRINT CLEARLY

INSTRUCTIONS TO APPLICANT: Review, fill out and mail this sheet with your Bible School application form to:
                                                                Bible School Registrar
                                                                Capernwray Harbour Bible Centre
                                                                PO Box 1-10
                                                                Thetis Island BC V0R 2Y0 CANADA

BIBLE SCHOOL YEAR
What year are you applying for?                                                                  September 20………. to May 20……….

BIBLE SCHOOL FEES for 2011 / 2012 ONE YEAR PROGRAMME:
$10,900 CAD

FINANCIAL PAYMENT OPTIONS:
                                Payment Date                                                                     Payment Amount
OPTION 1:                       JULY 1, 2011                                                                     $750 CAD *unchanged from 2010
                                SEPTEMBER 16, 2011 (registration)                                                $10,150 CAD

OPTION 2:                       JULY 1, 2011                                                                     $750 CAD *unchanged from 2010
                                SEPTEMBER 16, 2011 (registration)                                                $5,750 CAD
                                DECEMBER 1, 2011                                                                 $4400 CAD *unchanged from 2010
                                                                                                                 (post-dated cheque or credit card payment)

OPTION 3:                       JULY 1, 2011                                                                     $750 CAD *unchanged from 2010
                                SEPTEMBER 16, 2011 (registration)                                                $5,750 CAD
                                OCTOBER 1, 2011 – MAY 1, 2012                                                    $550 CAD per month *unchanged from 2010
                                                                                                                 (post-dated cheques or credit card payments)

FINANCIAL PAYMENT CHOICE:
I choose the following option to pay my Bible School Fees: ……….OPTION 1 ……….OPTION 2 ……….OPTION 3
I agree that the $750 CAD payment due July 1, 2011 guarantees my place in the Bible School and therefore is non-
refundable.

Applicant’s name

Applicant’s signature

Date

APPLICANTS, PLEASE NOTE: • Students are responsible for supplying their own financial support. Scholarships
                                                             are not available from Capernwray Harbour.
                                                           • All fees MUST be paid in Canadian dollars. Fees are considered a charitable
                                                             donation for Income Tax purposes in Canada.
                                                           • VISA & MASTERCARD are accepted.
                                                           • Canada Immigration Officers will require proof of financial support at the Port of
                                                              Entry into Canada and/or when issuing a student visa for non-Canadians.
PRIVACY POLICY: Capernwray Harbour Bible Centre is committed to protecting the privacy, confidentiality and security of student, guest and staff personal information and has a Privacy Policy viewable at our website
                   www.capernwray.ca (under TAB “More Info”) or can be obtained by contacting our Privacy Officer at 250-246-9440 (tel), 250-246-3201 (fax) or dsnyder@capernwray.ca.”



             M E M B E R                            T O R C H B E A R E R S                                                     I N T E R N A T I O N A L
                                        Credit card details
                                                         (optional)
                                                 PLEASE PRINT CLEARLY

INSTRUCTIONS TO APPLICANT: If you wish to pay the $40CAD application fee by credit card, please provide details
below:


We Accept: ……….Mastercard ……….Visa

Amount to be Paid ($CAD):

Card #:

Expiry date:

Name on card:

Authorized Signature:


Please keep my card on file to also be used for:

July 1, 2011 $750CAD Deposit                        ………..Yes ………….No
(Tax-receiptable)
Registration Day Tuition Payments                   ………..Yes ………….No
(Tax-receiptable)
Registration Day Additional Costs                   ………..Yes ………….No
(Books, Field Trips etc – Non-tax-receiptable)




                    Budgeting for Bible School
For many students each year we recognize that finances can be a struggle. The thought of paying for a year of tuition
can often be overwhelming! But the Lord remains faithful and loves to draw us to Himself as we learn to rely on Him,
especially in this area. While trusting the Lord for His leading and provision, the below are a few practical things we’d
like to highlight or suggest in order to help you plan your finances for Bible School:

1. The full Tuition Fees are considered a charitable donation for income tax purposes in Canada. For most, this
amounts to a substantial tax refund in the Spring. This would also be something to tell your church/friends/family who
may like to contribute towards your fees.

2. Consider whether your church family may like the opportunity to support you in this way. Many churches are happy
to make a donation towards a student who wishes to attend Bible School.

3. If you are working currently or plan to work before starting Bible School, consider disciplining yourself to set aside a
portion of what you earn each month in order to save. Christmas Break and Spring Break will also provide possible
opportunities to work in order to raise finances to put towards tuition fees.

      M E M B E R                T O R C H B E A R E R S                 I N T E R N A T I O N A L

				
DOCUMENT INFO
Description: Student Application Form for Play School document sample