Date received: ___________________ Accepted: Y
LIVING WORD
BIBLE COLLEGE
Application Fee Paid $__________ Date: ______________
Tuition Paid $ ________________ Date: ________________
DLI # 0213392219317
Acceptance Letter Sent: _____________________________
APPLICATION FORM
2015/2016
PERSONAL INFORMATION
LEGAL NAME: ________ ____________________________________________
Surname
Given names
CURRENT ADDRESS: __________________________________________________________________
Apt. #
Street
___________________________________________________________________
City
Province
Country
Postal Code
TELEPHONE: _________________________ Email: ___________________________________
Current Occupation __________________________________________________________________
BIRTHDAY:
__________________
Age __________
Birthplace __________________ /__________________
City
Country
☐
MARITAL STATUS:
☐ Single ☐ Married ☐ Separated
SEX:
☐ Divorced
☐ MALE ☐ FEMALE
☐ Remarried
Name of Spouse if married: ______________________________________________________
Note: If your spouse plans to take classes at LWBC, please have him/her complete a separate
application.
I heard about Living Word Bible College via: ________________________________________
(Name of Person)
IMMIGRATION STATUS:
N
☐ Canadian citizen ☐ Permanent resident ☐ Out of Country
Country of Citizenship _______________________ Date of Entry______________________________
* Note: International Applicants must also complete the International Student Form
1|P age
NEXT OF KIN:
In case of medical or other emergency, indicate name and telephone number of person* to contact:
Name ___________________________Phone _______________ Relationship ___________________
Address (if different from above) ________________________________________________________

For International Students, this should be the name and address of the person you would like us
to contact within North America.
SPIRITUAL INFORMATION:
Name and Address of Home Church _______________________________________________________
Denominational Affiliation ____________________________________________________________
PERSONAL REFERENCES:
Two Personal References are required using the forms at the end of this application.
One must be completed by a Pastor, Youth Pastor or Christian Leader, and the other completed by an
Adult Christian friend who is not a relative.
The completed reference forms should be forwarded directly to Living Word Bible College by the
individual completing the reference. For international students, reference forms may be submitted with
the application package, however, they must be in a separate, sealed envelope.
2|P age
MEDICAL INFORMATION:
Provincial Health Card Number: _______________________ Province: ____________________
☐ I live out of country and will require international student insurance.
1. Please list any medications you must take on a regular basis ___________________________
2. Have you ever received treatment for a mental disorder? ☐ No ☐ Yes, explain: _________
3. Check any of the following conditions that you have had and provide the approximate date:
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
ADD, ADHD _____________________
Asthma __________________________
Diabetes _________________________
Epilepsy _________________________
Fainting _________________________
Headaches _______________________
Heart Problems ___________________
Hepatitis ________________________
Measles _________________________
Mononucleosis ___________________
Mumps __________________________
Polio ____________________________
Rheumatic Fever _______________________
☐ Small Pox _____________________________
☐ STD’s ________________________________
☐ Tuberculosis __________________________
☐ Typhoid ______________________________
☐ Other: ______________________________
☐ Anxiety Disorder _______________________
☐ Eating Disorders _______________________
☐ Social Difficulties _______________________
☐ Clinical Depression _____________________
☐ Allergies - Specify: _____________________
_____________________________________
☐
We recommend that you have a medical checkup prior to arriving as a student at the Living Word
Bible College. Please notify us of any medical condition which may interfere with your studies.
Note: International students will require a complete medical checkup prior to receiving a Study
Visa.
3|P age
FEE SCHEDULE – 2015/2016
FULL-TIME STUDENTS


Application Fee (Canadian Students)
Application Fee (International Students)
Tuition Fee & Room and Board
$25.00 - Send with this application
$100.00 – Send with this application
SEMESTER 1
SEMESTER 2
$ 3125.00
$ 3125.00
o Note: International Students arriving with Sponsored financial support - Tuition &
Room/Board fees must be paid in full (entire year) by the first day of class
Other Fees:
Official Transcript Fee
$ 20.00 per request
PART-TIME STUDENTS
Tuition Fee - per credit hour
Audit Fee – per credit hour

$ 120.00 ($360 / course)
$ 50.00 ($150 / course)
Accommodations (Room and Board) for part-time students are available for a fee of $50 per
day.
4|P age
Payment Options
Application Fee: (Must be included with this application)
☐$25 for Canadian students
☐$100 for International students
Tuition Fees:
☐I am enclosing a money order or bank draft for a full year, in the amount of $6,000 CDN
☐I prefer to make installment payments for each semester:
☐Fall Semester - $3,125 CDN due First day of class in September 2015
☐Winter Semester - $3,125 CDN due First day of class in January 2016
Payment may also be made by Credit Card.
Please charge my ☐ Visa (or) ☐ MasterCard for the amount of $ _______________________
Name as it appears on Card _____________________________________________________
Card # ___________________________________________
Signature ___________________________________
Expiry Date _____ _____
mm / yy
Date _______________________
I certify that all the information in this application is complete and accurate. I understand that payment
of all fees must be made as outlined in this application unless otherwise approved by the President of
Living Word Bible College.
If accepted, I will uphold the standards of the College with regards to moral and Christian conduct. I will
abide by the College rules and discipline, and obey those in leadership at Living Word Bible College.
Signed _______________________________________________ Date _________________________
Please send application form and application fee of $25 (for Canadian Students) or $100 (for
International Students) to:
Living Word Bible College
Box 969
SWAN RIVER, MANITOBA ROL IZO
CANADA
Or by email to lwbc@mts.net
5|P age
REFERENCE FORM #1 - Pastor, Youth Pastor, Christian Leader (non-relative):
Applicant name: ______________________________________________________________________________
Please complete the following reference form with respect to the above mentioned applicant. The back side of this form may
be used should you require more space to answer the questions. Please fill out this form and submit in a sealed envelope to
the following address: Living Word Bible College, Box 969, Swan River, MB, R0L 1Z0, Canada
Name: __________________________________
Organization: __________________________________________
Address: _______________________________________________________________________________________
Phone: ___________________________________ Email: _______________________________________________
How long have you known him / her? _________________ yrs.
Does the applicant regularly attend your church? If not, please explain your relationship to the applicant.
_______________________________________________________________________________________________
What ministries has the applicant been involved with in your church or youth group?
________________________________________________________________________________________________
Have you ever had occasion to question the applicant’s moral conduct? Please explain.
_______________________________________________________________________________________________
To your knowledge, does the applicant have addictive habits such as smoking, drinking or use of non-prescription drugs?
 Yes
 No
Briefly describe the applicant’s personality or character traits.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please comment on how well you would expect the applicant to succeed at Bible college with respect to the following areas:
Academically, Socially, and Spiritually.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Do you have any reservations in recommending the applicant for studying at LWBC? If yes, please explain.
 Yes
 No
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I declare that the contents of this confidential reference form are correct to the best of my knowledge.
Signature: _________________________________________
Date: ____________________________________
6|P age
REFERENCE FORM #2 - Adult Christian friend (non-relative):
Applicant name: ______________________________________________________________________________
Please complete the following reference form with respect to the above mentioned applicant. The back side of this form may
be used should you require more space to answer the questions. Please fill out this form and submit in a sealed envelope to
the following address: Living Word Bible College, Box 969, Swan River, MB, R0L 1Z0, Canada
Name: __________________________________
Organization: __________________________________________
Address: _______________________________________________________________________________________
Phone: ___________________________________ Email: _______________________________________________
How are you acquainted with the applicant? ____________________________________________________________
How long have you known him / her? _________________ yrs.
To your knowledge, does the applicant regularly attend church? ______________________________________________
Are you aware of any ministries the applicant been involved with in his / her church or youth group?
________________________________________________________________________________________________
Have you ever had occasion to question the applicant’s moral conduct? Please explain.
_______________________________________________________________________________________________
To your knowledge, does the applicant have addictive habits such as smoking, drinking or use of non-prescription drugs?
 Yes
 No
Briefly describe the applicant’s personality or character traits.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please comment on how well you would expect the applicant to succeed at Bible college with respect to the following areas:
Academically, Socially, and Spiritually.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Do you have any reservations in recommending the applicant for studying at LWBC? If yes, please explain.
 Yes
 No
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I declare that the contents of this confidential reference form are correct to the best of my knowledge.
Signature: _________________________________________
Date: ____________________________________
7|P age
INTERNATIONAL STUDENT INFORMATION
International Applicants:
 Must be at least 18 years of age;
International Student Authorization for Studying in Canada:

Anyone wishing to study in Canada who is not a Canadian citizen or permanent resident must
obtain a student authorization before entering Canada. Those students in Canada on a
visitor's visa must leave Canada and re-enter with the Student Authorization. Students should
contact the nearest Canadian embassy, high commission or consulate once they are accepted
to Living Word Bible College. To obtain your student authorization, the following
documentation will be required:
o Acceptance letter to Living Word Bible College, including information about t he
expected time to complete the program.
o Proof of financial support - the visa officer will expect you be able to support yourself
during your program of study (may need to present financial documents to prove you
have the necessary funds). Or, you may be required to show that you have support
from another individual or organization (Sponsor).
o Proof of medical clearance (depending on country of residence).
Once this documentation is in order, Canadian Immigration authorities will issue an authorization /
entry visa for Canada. This must be presented to the Immigration Officer when you enter Canada
and they will issue the study permit.
I understand the above requirements for acceptance to study at Living Word Bible College. I am
applying to come to Canada for the sole purpose of studying at the Living Word Bible College. I
understand that Living Word Bible College is an English speaking college and that I will be required
to speak, read, write and study, in English while attending Bible College.
By signing this form I understand the requirement stated and agree to its terms.
Name: (Please print)___________________________________________________________________
Signature: __________________________________________ Date: _______________________________
8|P age
INTERNATIONAL STUDENT SPONSOR FORM
I ________________________________ (sponsor) agree to pay for all fees, including tuition, room and
board, for one year of studying at Living Word Bible College for
___________________________________ (student).
I understand that if the applicant receives a Canadian Student Visa and comes to North America through
our letter of invitation but does not attend our college, or does not complete the college year as
outlined, the money will not be refunded.
_____________________________________________________ _____________________________
Signature of Sponsor
Date
Payment options (choose 1):
☐I am enclosing a money order or bank draft in the amount of $6,250 CDN).
☐Full payment will be sent with the student upon arrival
Payment may also be made by Credit Card.
☐Please charge my
☐ Visa (or) ☐ MasterCard for the amount of $ _____________
Name as it appears on Card ____________________________________________
Card # ______________________________________
Expiry Date _____ /_____
mm / yy
Signature _________________________________ Date ___________________________
Sponsor contact information (please print clearly):
_____________________________________________________________________________________
Name of Sponsor
______________________________________
Mailing Address
__________________________________________
City
_____________________________________________________________________________________
Province
State
Country
Postal/Zip Code
__________________________________________ ________________________________________
Email Address
Telephone
9|P age