Prospective Student's Full Name *

Prospective Student's Phone # *

Prospective Student's Email *

Address *

City *

State *

Postal code *

Gender *

Do you plan on bringing any guests with you? (i.e. parents, siblings, pastor) *

Which Preview Day(s) do you plan to attend?

Guest Information

If you are bringing a guest who is also interested in attending Bethlehem College and Seminary, please have them register separately. This will help us serve them well as a prospective student.

Guest 1 (name, age, relationship to you) *

Guest 2 (name, age, relationship to you)

Guest 3 (name, age, relationship to you)

Guest 4 (name, age, relationship to you)

Guest 5 (name, age, relationship to you)

Student Information

How did you first hear about Bethlehem College and Seminary? *

What program are you interested in? *

When are you looking to start? *

High School Graduation Year *

Date of birth *

What is your t-shirt size?

Additional Information

Do you or any of your guests have any food allergies we should be aware of? Please list below. (i.e. allergy, number of people with allergy) *

Submitting this form constitutes your expressed written consent to be called and/or texted by Bethlehem College and Seminary at the number you provided. You understand that these calls may be generated using automated technology and you can opt out at any point in time.