Sex _______ Male ________ Female Social Security Number: __ __ __ __ __ __ __ __ __

Spouse's Name: __________________________________________________________

Address Line 1: __________________________________________________________

Address Line 2:__________________________________________________________

City: _____________________ State: __________________ Zip Code: ______________

Home Phone: ________________________ Business Phone: _______________________

Age: _____Date of Birth: _____________ Occupation: ____________________________

Marital Status: _________________When you were saved: _________________________

Degree Program Desired: _____ Associate _____ Bachelor _____ Master _____ Doctorate

List any specialized Christian service: __________________________________________

Place and Name of High-school Graduated from: _________________________________

College: ________________________________________________________________

Your local Church's Name and Address: _______________________________________

Print Your Name as you wish it to appear on our official records:

______________________________________________________________________

I have read the catalog and state that all above is true and will abide by the rules of
Jacksonville Baptist Theological Seminary. Application fee is $50.00.

I have read and understand the Refund Policy.

Signed ______________________________________________ Date_______________

Make checks payable to JBTS Houston Study Center & mail with application to:

Dr. Jack Zimmerman, 19510 Teller Blvd., Spring, TX 77388-6126

Transfer students: Official transcripts (2 each) must be mailed directly from the college/university/seminary to Dr. Zimmerman at the above address.