Dual Enrollment Online Application Form
Please read the application form in its entirety before filling it out. Once you have all the information and are ready to submit, you can fill out the form and proceed to paying the $25 application fee at the bottom of the application. If you have any questions, please don't hesitate to contact our registrar at registrar@nebc.edu or 207-947-1665.
Personal Information
Legal Name
*
Last Name
First Name
Middle Name
Preferred Name
Mailing Address
*
Number & Street
City
State / Province
Postal / Zip Code
Phone Number
*
Primary Phone
Secondary Phone
Email Address
*
example@example.com
Sex
*
Birth Date
*
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Month
-
Day
Year
Date
Citizenship
*
If dual U.S. Citizen or Foreign Citizen, please specify the other country of which you are a citizen.
If you are on U.S. Permanent resident visa, please specify the country of which you are a citizen
Family Information
If you are younger than 18, please complete Parental Information
Father's Name
First Name
Last Name
Father's Contact Information
Email
Phone
Mother's Name
First Name
Last Name
Mother's Contact Information
Email
Phone
Marital Status
Spouse's Name
First Name
Last Name
Children's Names and Ages
Contact in Case of Emergency
Phone
Relation to you
Educational Information
Please indicate when you intend to begin study:
*
Year
Semester * Fall / Spring
When did you apply?
List all high schools attended. For school type, specify whether public, private, Christian or homeschool.
Anticipated date of graduation
*
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Month
-
Day
Year
Date
List all colleges and universities attended.
Religious Information
Have you received Jesus Christ as your Savior?
*
Yes
No
Church Name and affiliation
What does it mean for you to live as a follower of Christ?
Additional Questions
Have you ever had to leave an educational institution for academic or disciplinary reasons?
*
Yes
No
If yes, please explain why:
Have you ever been convicted of a felony?
*
Yes
No
If yes, please explain:
Pastoral Reference
Pastoral Reference (should not be a relative)
*
First Name
Last Name
Church
Position
Email Address
Primary Phone Number
Secondary Phone Number
Community Covenant
Christian maturity involves a commitment to the lordship of Christ, to the truth of God’s Word, to a life of dynamic discipleship, and a renunciation of self-centeredness. The mature Christian recognizes that scriptural principles govern both thought and conduct, and seeks to apply these principles to attitude, conviction and behavior.We, as a community, endeavor to live our lives in accordance with such biblical principles as stated in our Statement of Faith, our Mission and Purpose, and our Community Standard of Behavior (see website). This commitment to Christian maturity is expected of each NEBCS student. Please read the Statement of Faith, the Mission and Purpose, and the Community Standard of Behavior to determine whether you can unreservedly join in fulfilling them.
If you have any questions, reservations, and disagreements, please explain below:
" I affirm that I have carefully read the Statement of Faith, the Mission and Purpose, and the Community Standard of Behavior and that these express my own convictions and commitments and that if accepted as a student, I will gladly fulfill the responsibility of abiding by them.”
Date
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Month
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Year
Date
“I affirm that by my signature that all information contained in the application is my work, factually true and honestly presented.”
Date
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Month
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Day
Year
Date
As the parent/guardian of this student, I approve and support their application to NEBCS:
Date
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Month
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$25 Application Fee
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Application Fee
$
25.00
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Credit Card
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