PLEASE COMPLETE THIS FORM. INFORMATION MUST BE TYPED OR PRINTED DIRECTLY ON THIS FORM.
NAME: _________________________________________________________________
ADDRESS: _______________________________________________________________
CITY: __________________________________ STATE: ________ ZIP: _____________
PHONE: (HOME) ____________________________ (CELL) ________________________
EMAIL: _________________________________________________________________
CHURCH NAME: ___________________________________________________________
CHURCH ADDRESS: _________________________________________________________
CITY: __________________________________ STATE: _________ ZIP: _____________
PHONE: ________________________________
STAFF POSITION: ______________________________ EMPLOYMENT DATE: _______________
STATUS: (CHECK ONE) FULL-TIME ______ PART-TIME ______ VOLUNTEER _______
SUPERVISOR*: __________________________________ PHONE: ______________________
EMAIL: ____________________________________________________________________
(*IF YOU ARE THE PASTOR, LIST THE CHAIR OF DEACONS, ELDERS OR PERSONNEL PLEASE)
COLLEGE OR SEMINARY: ________________________________________________________
ADDRESS: __________________________________________________________________
CITY: __________________________________ STATE: _________ ZIP ______________
ADMISSIONS/REGISTRAR OFFICE TELEPHONE: __________________________________________
STUDENT ID NUMBER: ______________________________
DEGREE SEEKING: _____________________________________________________________
HOURS REQUIRED TO GRADUATE: ___________ GRADUATION DATE: ________________________
ANTICIPATED "OUT OF POCKET" TUITION COSTS FOR UPCOMING SEMESTER: $_______________________
LIST ANY SCHOLARSHIPS, GRANTS, OR GIFTS RECEIVING DESIGNATED FOR EDUCATION (AND AMOUNT):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
RETURN ALL COMPLETED APPLICATION MATERIALS TO THE FBA VIA:
MAIL: THE FLORIDA BAPTIST ASSOCIATION, 1839 JACLIF COURT, TALLAHASSEE, FL 32308
EMAIL: SCAN ALL DOCS A .PDF AND EMAIL TO SMCMAHON@FLORIDABAPTISTASSOCIATION.ORG
APPLICATION MATERIALS MUST BE RECEIVED BY DEADLINE PUBLISHED.