Liberty Hall Bible Institute
New Jersey Campus

REGISTRATION

Student Information

First name

Last name

Birthday

Month

Day

Year

Gender

Male

Female

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

Course of Study

Select Course

Proposed Start Date (Month, Year)

Tuition & Payments

Who is expected to pay your tuition?

Yourself

Sponsor

Education

Have you previously studied in the US?

Yes

Education Completed

Less than High School

High School

College/University

Select all that apply.

Personal Statement

Please state why you want to undertake this course, any relevant experience, skills and attributes, and your long-term goals.

Professional Reference

All applicants must provide one reference. The reference should be a teacher/professor if you have been in education within the last two years or your current or most recent employer.

Name of Reference

Title & Organization

Relationship to You

Reference Email Address

Referral Source

How did you find out about this school/course?

Support Requirements

Please complete this section if you have any learning support/mobillity requirements.

Do you have a disability, medical condition, or require learning support?

Yes

Church Information

Church Name

Pastor's Name

Church Address

Church Email

Declarations

Data Protection Act 1988

I agree to Liberty Hall Bible Institute New Jersey (LHBINJ) processing personal data contained in this form or other data which LHBINJ may obtain from other people. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any legitimate reason, including communication with me following the completion of my studies.

In addition, I agree to LHBINJ processing personal data described as ''Sensitive Data'' within the meaning of the Data Protection Act 1988, such processing to be undertaken for any purposes as indicated in the declaration above.

If my employer/sponsor is supporting my studies by paying my fees/allowing me study time, I agree to my employer/sponsor being informed of the progress of my application and of my studies if I am accepted into the course.

I agree.

Consent

I agree that my photos and testimonials can be used for administrative and marketing purposes.

Upload any photos and documents.

Applicant Certification

I certify that, to the best of my knowledge, the information I have provided is complete and true.

Signature

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Registration Fee

Once you click the submit button on this form, you will be taken to the checkout page to pay the registration fee. Your registration is not considered submitted until the registration fee is paid.

2025 Registration Fee

$80

I understand that the one-time registration fee for each course of study is non-refundable and is separate from the tuition for the course.

TUITION & PAYMENTS

Liberty Hall Bible Institute New Jersey Campus