TEXAS BIBLE INSTITUTE

Application for Enrollment

Please Read Carefully

The application process will not begin until all required forms are received. Please attach a clear and current photograph suitable for
publication.

Which TBI Program are you applying for?

__ _ The Discipleship Program ___ The Joshua Coalition ___ The Leadership School
Fall Semester only For TBI Alumni Spring Semester only

The Discipleship Program- Section F is not required.

The Joshua Coalition- Section C is not required.
The Leadership School- Section C is not required for alumni. Section F not required for new applicants.

.SECTION A -- General Information...

(For all applicants)

Name_________________________________________________ Sex: _____Male _____Female

Last First Middle

Present Address_____________________________________________________________________________

City____________________ State______________ Zip______________

Country________________________

Cell Phone No.( )__________ Email ________________________ Social Security# ___________________

Current Age _______ DOB ___/___/____ Citizenship_____________________________________________

MM/DD/YY
Ethnicity: ____ African-American ___Asian ___Caucasian ___Hispanic ___Othe r

Is English your primary language? ___ Yes ___ No If no, what is? ____________________
*To ensure that our students flourish academically, we require that all incoming students must be able to read, write, and speak English.

Marital Status: ___Single ___ Engaged ___Married ___Separated ___ Divorced

How did you hear about TBI? __________________________________________________________________

Parental Information

Check One: ___ Father ___Mother ___Grandparent ___Guardian ___Other

Name ______________________________________ Home Phone No. ( )__________________________
Address _____________________________________ Work Phone No. ( )__________________________
City ________________________________ State ____________________ Zip _________________________
Email _____________________________________________________________________________________

Check One: ___ Father ___Mother ___Grandparent ___Guardian ___Other

Name ______________________________________ Home Phone No. ( )__________________________
Address _____________________________________ Work Phone No. ( )__________________________
City ________________________________ State ____________________ Zip _________________________
Email _____________________________________________________________________________________

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
 Section A, Page 2

Christian Experience
What religion were you raised in? ___ Christian ___Jewish ___ Muslim ___None Other _______
Have you accepted Jesus Christ as your personal Savior? ___ Yes ___ No
When did you get born again? ___ As a child ___As a teen ___Less than one year ago
List the name of the church that you currently attend.
Name of Church ____________________________________________________________________________
Pastor __________________________________________ Youth Pastor _______________________________
How long have you attended this church? ___A few months ___ A few years ___Entire Life
Do you attend church activities? ___ Periodically ___Weekly ___ Bi-monthly
What activities are you currently involved in at your church?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
If you are not currently involved in you local church, please briefly explain why.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Personal Information
Do you have children? Yes___ No___ If yes, what are their ages? _______________
Check any area that you need help in overcoming:
___Shyness ___Fear of Failure ___Laziness ___ Loneliness ___Homosexuality
___Smoking ___Alcohol ___ Drugs ___ Eating Disorders ___Pornography
___Anger Issues ___ Low Self-Esteem ___Theft ___ Rebellion ___None of these

How often are you tempted in those areas? ___ Daily ___Weekly ___ Monthly
Are you ready for some long term solutions? ___Yes ___ No
What illegal/habit-forming drugs have you used?
______________________________________________________
When was the last time you used illegal/habit-forming drugs? ___N/A ___Past 90 days ___Over a year
Have you ever been arrested? ___Yes ___No
If yes, explain:
______________________________________________________________________________
Were you convicted? ___Yes ___No
If yes, explain:
______________________________________________________________________________
Are you on probation? ___Yes ___No
If yes, explain:
______________________________________________________________________________
Have you ever been medicated or treated for an emotional or mental disorder? ___Yes ___No
If yes, explain:
______________________________________________________________________________

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
 Section A, Page 3

Education
Name of School City State Date of Graduation
__________________________________________________________________________________________
__________________________________________________________________________________________
Were you homeschooled? ___Yes ___No
Have you had any technical or vocational training? ___Yes ___No
If yes, please explain what type of training you have received:
__________________________________________________________________________________________
Have you ever been denied acceptance by another school? ___Yes ___No
Have you ever been expelled or suspended from any school or college? ___Yes ___No
If yes, why?________________________________________________________________________________
Do you have any learning disabilities or special education needs? ___Yes ___No
If yes, please describe:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Employment Experience
Please list your previous work experience, starting with the most recent employer:
Name of Employer Duties Performed
__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________

Additional Information
Briefly state why you would like to attend Texas Bible Institute:
__________________________________________________________________________________________
__________________________________________________________________________________________

I understand that attendance to TBI is a privilege and not a right. By signing and submitting this application, I
agree to conform to the standards and regulations established by the administration, both those printed and those
that may be announced in the course of each school year.

_______________________________________ ____________________
Signature of Applicant Date

_______________________________________ ____________________
Signature of Parent/Guardian (required if applicant is under 18 years of age) Date

Please return all required sections promptly to:

TEXAS BIBLE INSTITUTE

P.O. BOX 100
COLUMBUS, TX 78934
ATTN: OFFICE OF ADMISSIONS

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
.SECTION B -- Medical History Form...
(To be completed by parent or guardian if student is under age 18.)

Student Information
Full Name________________________________ DOB ___/___/___ Age ___ Sex F___ M ___
Emergency Notification
Parent/Guardian__________________________ Phone_____________ Work ____________ Cell ___________
Other Contact ___________________________ Phone_____________ Work ____________ Cell ___________
Address _______________________________ City_______________ State___________ Zip_____________
Phone_____________________ Mobile___________________ Office____________ Other ________________
Physician__________________________________ Phone _____________________________
Dentist ___________________________________ Phone _____________________________
Insurance
Insurance Co. __________________ Policy Holder Name and DOB ________________________ ___/___/___
Policy of Group # _______________ Insurance Co. Phone # _________________________________________
Emergency Medical Information
Does the student have any of the following medical conditions?
Yes___ No___ Allergies (food, medicine, plant, animal, or insect) Yes___ No___ Epilepsy/Seizures (convulsions)
Yes ___ No ___ Asthma Yes ___ No ___ Depression
Yes ___ No ___ Diabetes Yes ___ No ___ Suicidal Thoughts
Yes ___ No ___ Heart Disease or defect Yes ___ No ___ HIV Virus (AIDS)
Yes ___ No ___ Bleeding or clotting disorder Yes ___ No ___ Sexual Transmitted Disease
Yes ___ No ___ Hypertension Yes ___ No ___ Frequent or Current
Infections
Yes ___ No ___ Back or Joint Pain (eye, ear, throat, respiratory, urinary tract, vaginal)
Yes ___ No ___ Stomach or Intestinal infection or other condition Yes ___ No ___ Cancer
Yes ___ No ___ TB Yes ___ No ___ Mononucleosis
Yes ___ No ___ Disabilities or Chronic or Recurring Illnesses
Yes ___ No ___ Other _______________________________
Explain any yes response fully, including date of diagnosis, frequency and severity of symptoms, treating
physician, required monitoring, regular and emergency treatments (e.g., Epipen).
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever required psychiatric counseling or hospitalization? Yes___ No___ Explain: __________________
__________________________________________________________________________________________
Operations or serious injuries (dates): ____________________________________________________________
Activities encouraged or limited by physician:______________________________________________________
Please describe any special dietary needs or restrictions. _____________________________________________

Medications
Prescription Dosage Schedule (e.g., am or pm) Condition Other Instructions
Medication

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
 Section B, Page 2

Immunizations

*All students must have met the bacterial meningitis compliance requirement (MCV4) within the past five
years. A proof of vaccination must be in the TBI admissions office 10 days before the students arrival.
Available at private clinics, TX. Dept. of Health, CVS or Walgreens and many low-cost clinics. All other
vaccines are recommended.

Dose 1 Dose 2 Dose 3 Dose 4

Vaccine Date Administered
(month/day/year)

Meningococcal (Required)

(Recommended vaccines listed below)

Dipteria/Tetanus/Pertussis
(DTaP/DTP/DT/Td/Tdap)

Polio

Measles, Mumps, Rubella (MMR)

Hepatitis A

Hepatitis B

Varicella

Acknowledgement And Release

READ CAREFULLY BEFORE SIGNING
This health history and immunization report is true to the best of my knowledge. I will notify the school promptly if there is any
change in the student's medical condition prior to the start of the semester. In the event of an illness or emergency, I hereby give
permission for the staff of Texas Bible Institute to provide directly or authorize medical treatment of the student by the on-campus
medical response team and when necessary, authorize transportation, to and from the medical facilities designated by Texas Bible
Institute for the care of the student. I authorize Texas Bible Institute and third-party caregivers to exchange pertinent medical
information. Upon completion of medical treatment, I authorize the medical facility providing treatment to release diagnostic
information to Texas Bible Institute for follow up and for the student's medical file. I hereby agree to release from liability and hold
harmless Texas Bible Institute, Burchfield Ministries International and each of their directors, officers, employees, agents, and
representatives, and other integrated auxiliaries from any and all liability, claims, and demands of any kind or nature, either in law or
in equity, which arise now or in the future in connection with the student's attendance at Texas Bible Institute. I understand and agree
that this release discharges the released parties from any liability or claim that I or the student may have against them with respect to
bodily injury, personal injury, illness, death, or property damage that may result from the student's attendance at Texas Bible
Institute. I and the student expressly waive any right to a trial by judge or jury that we may otherwise have with regard to any claim or
liability to the student's attendance at Texas Bible Institute. I and the student expressly waive any right to a trial by judge or jury that
we may otherwise have with regard to any claim or liability to the student's attendance at Texas Bible Institute.

_____________________________________________________________ _________________________________
Parent/Guardian Signature (or Student’s Signature if age is 18 or older) Date
______________________________________________________________________________________________________
Parent/Guardian’s Printed Name

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
.SECTION C -- Minister’s Recommendation Form...
(Time length: Approximately 4 minutes.)

Applicant
To be completed by your pastor or minister who knows you best. This document is to be mailed directly by them to the Admissions
Office of T.B.I.

Name__________________________________________________ Sex: ___Female ___Male

Last First Middle
Phone Number: ( ) ________________ or ___________________ Email: ________________________
Minister
The above named person is applying for enrollment to Texas Bible Institute. If the applicant is accepted, your input will contribute
to adjustments necessary for their personal development. Applications are not processed until all forms have been received.

Minister’s Name __________________________________ Denomination_______________________________

Church/Organization Name ____________________________________________________________________
Address ___________________________________________________________________________________
Street City State Zip
Phone Number: ( ) _______________________ Email: __________________________________________
Relationship to the Applicant:
___Pastor ___Associate Pastor ___Youth Pastor ____Church Leader (Other)__________________
1. How long have you known the applicant? ___0-6 months ___6 mos-2yrs ___ 2-5 yrs ___5-10 yrs
2. How well do you know the applicant? ___ Very well ___ Well ___ Casually
3. Is the applicant faithful in attendance? ___ Yes ___ No
4. Does the applicant’s family support his or her desire to attend T.B.I.? ___Yes ___ No
5. Please provide input about the applicant’s Christian experience
___Questionable Conversion ___Struggles with Christian commitment ___Committed Christian
Please evaluate the applicant’s personal character (Check the appropriate number corresponding to the following
scale):
1 - Unknown 2 - Average 3 - Excellent
Honesty ☐1 ☐2 ☐3 Consistent Christian Life ☐ 1 ☐ 2 ☐ 3 Dependability ☐1☐2☐3
Financial Responsibility ☐ 1 ☐2 ☐3 Ability to Cooperate ☐ 1 ☐ 2 ☐ 3 Ability to work with others ☐ 1 ☐ 2 ☐ 3
Ability to lead others ☐ 1 ☐2 ☐3 Personal Cleanliness ☐ 1 ☐ 2 ☐ 3 Self Image ☐1☐2☐3
Leadership Potential ☐ 1 ☐2 ☐3 Emotional Stability ☐ 1 ☐ 2 ☐ 3 Church Involvement ☐1☐2☐3
Respect for authority ☐ 1 ☐2 ☐3 Interpersonal Skills ☐ 1 ☐ 2 ☐ 3 Parental Support ☐1☐2☐3
General Comments
__________________________________________________________________________________________
__________________________________________________________________________________________
I recommend this applicant for admission to Texas Bible Institute:
___Unreservedly ___With reservations ___I do not recommend
Signature of Reference ______________________________________________ Date:___________________

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
SECTION D -- Financial Agreement Form...
(For all applicants)

By signing this financial agreement form:

● I agree to make 4 payments of amount listed below on or before the due date.
● I understand that the first payment is non-refundable and non-transferable.
● I appreciate TBI’s effort to remain the lowest cost Bible school in the nation.

Which TBI Program and Financial Agreement Form are you agreeing to? Check one.
____ The Discipleship Program $1,195*
4 Payments of $298.75 each month starting August 1, 2018

____ The Leadership Program $1,195*

4 Payments of $298.75 each month starting December 1, 2018

____ The Joshua Coalition $995* (For TBI Alumni only)

4 Payments of $248.75 each month starting September 1, 2018

Financial Directives:
● Payments are due in the TBI Financial Office on or before the 1st day of each month.
● The final tuition payment is due on or before :
The Discipleship Program November 1, 2018
The Joshua Coalition December 1, 2018
The Leadership School March 1, 2018
● A graduation fee of $35 should be paid with or before the final payment.
● A student will not be permitted to remain in school if tuition payments are not current.
● These prices are for the Fall/Spring Semesters of the 2018-2019 school year only.

_________________________________________ __________________________________________
Name of Student (Please print) Name of Parent, Guardian, or Responsible Party
_________________________________________ __________________________________________
Address Address
_________________________________________ __________________________________________
City State Zip City State Zip

_________________________________________ __________________________________________
Signature of Student Signature of Parent, Guardian, or Responsible Party
_________________________________________ __________________________________________
Date Date

*Total Program Costs include tuition, books, food, lodging, weight room and transportation to church. No hidden fees.
For information concerning refunds due to withdrawal or a change in student status, please refer to our Texas Bible Institute
Handbook at www.texasbibleinstitute.org.

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
.SECTION E -- Release & Waiver of Liability...

I, my minor child, or a minor child under my legal guardianship, (individually and collectively referred to as Participants),
intend to participate in one or more of the following programs of Texas Bible Institute, (TBI) and as a participant. Participants
assume all responsibility for Participants' own safety while participating in the Program. Participants understand that the
Program may involve participation in exercises which are physically demanding and could involve possible hazards, not all
of which can be foreseen. Participants further understand that participation in the program is completely voluntary, and
Participants assume the risk of any and all injuries that may occur to Participants as a result of participation in the program.
I hereby assume all risks of participation and/or volunteering in activities associated with my tenure as a Texas Bible
Institute student (herinafter Activities’). By executing this Student Liability Release form, I hereby release the following
entities or persons: Burchfield Ministries International and Texas Bible Institute and/or said entities, directors, officers,
employees, volunteers, representatives, and agents, and the Activities’ holders, sponsors, or volunteers (herinafter
Released Parties). I acknowledge that this Waiver and Release of Liability Form will be used by the Released Parties and
that it will govern my actions and responsibilities in my participation in the Activities.
In consideration of my participation in Activities or events, I hereby agree on my own behalf and on behalf of my executors,
administrators, heirs, next of kin, successors, and assigns as follows:
(A) I waive, release, and discharge the Released Parties, for my death, disability, personal injury, property damage,
property theft, or actions of any kind which may hereafter occur to me as a result of my participation in the
Activities including any damage or injury that may occur during my traveling to or from any said Activities.
(B) I Indemnify, hold harmless, and promise not to sue the Released Parties for any and all liabilities or claims made as
a result of my participation in the Activities, whether caused by the negligence of the Released Parties or otherwise.
I acknowledge that the Released Parties are NOT responsible for the errors, omissions, acts, or failures to act of
any party or entity conducting the Activities.
I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident, and/or
illness during the Activities.

I understand that at the Activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for
any legitimate purpose by the activity or event holders, producers, sponsors, organizers, and assigns produced by
Burchfield Ministries International.

Participants expressly agree that this Release is intended to be as broad and inclusive as permitted by laws of the State of
Texas and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas.
Participants further agree that in the event any clause or provision of this Release is deemed as invalid, the enforceability of
the remaining provisions of this Release shall not be affected. I agree that this release shall be governed by the laws of the
State of Texas and venue for any dispute over this release shall be in Colorado County. I further agree that if I attempt to
break this release, I will be liable to reimburse the Released Parties for their attorneys’ fees in defending the same.

I certify that I have read this document, and I fully understand its contents. I am aware that this release of liability and a
contact and I sign it of my own free will.

____________________ ________ _______________________________ ____________

Print Student’s Name Age Signature of Student Date

______________________________________
Signature of Parent/Guardian
(Required if student is under 18 years of age)

MUST BE FAXED OR MAILED

FAX: (888) 519-5756
PO Box 100
Columbus, TX 78934

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
.SECTION F -- TBI Alumni Personal Review Form...
Name_____________________________________________________________________________________
Last First Middle

Phone Number (____)_______________________ Email ____________________________________________

1. What year did you graduate from TBI’s Discipleship Program? __________________________________
2. Who on the TBI/BMI Staff could give you recommendation? ____________________________________
3. Rate your personal level of leadership during TBI: (1 to 10, with 10 being the best)
________ Consistency of personal devotions
________ Daily Bible reading
________ Prayer Culture involvement
________ Positive influence in dorms
________ Work Ethic
________ Involved in Prayer Pocket
________ Friendliness
4. Were you ever on Academic Probation? ____ Yes ____ No
5. Were you ever on Disciplinary Probation? ____ Yes ____ No
6. What was your final GPA for Term #1 ______ Term #2 ______ Undetermined ______

Leadership Tracks
(For all applicants to The Leadership School)
All students will be enrolled in The Core Leadership Courses and a Leadership Track. Track selections cannot be
guaranteed, however, every effort will be made to fulfill each student’s request. Please select two of the Leadership
Tracks you are most interested in with a #1 and #2.

____ School of Business Management

____ School of Media Ministries

____ School of Music Ministries

____ School of Student Ministries

(Nursery, Toddlers, Children, Youth, College & Career)

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
.SECTION G -- Background Check...
Background Check Process 
Every Student applying must have this form lled out. 
 
Texas Bible Institute requires all students to have a criminal and sexual o ender background check run. All adults must 
have a completed form. 
 
Have you ever been convicted of a felony? ____Yes ____ No 
If yes, explain_________________________________ 
Date of conviction ___/___/___ 
 
AUTHORIZATION FOR BACKGROUND CHECK FORM 
 
(Please read and sign this form in the space provided below. Your written authorization is necessary for completion of 
this application process.) 
 
I, ________________________, hereby authorize Texas Bible Institute to investigate my background for purposes of 
evaluating whether I am quali ed for the position for which I am applying. I understand that Texas Bible Institute will 
utilize an outside rm or rms to assist it in checking such information, and I speci cally authorize such an 
investigation by information services and outside entities of the company’s choice. I also understand that I may 
withhold my permission and that in such a case, no investigation will be done, and my application to attend will not be 
processed further. 
 
Signature_________________________ Date____/___/___ 
 
First  Middle Last 
Applicant’s Name - Printed 
 
______-______-______ 
Applicant’s Date of Birth 
Social Security Number: ____-____-____ 
Address: ____________________City: ________________State: ____ 
Email:_______________________________ 
 
O ce Use Only 
Date of Background Check_________________ 
Criminal Record ________________ 
Sexual O ender Record______________ 
Check run by____________________ 
Signature__________________________

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG 
  
TBI is the most cost-effective Bible  
school in the nation of its kind. 
 

Total Program Cost Includes:

Texas Bible Institute is firmly committed to providing exceptional academics and activities in a Christ-centered
environment. TBI is the most cost-effective Bible school in the nation of its kind.

School Tuition, Housing, Books and Meals

Trained and educated faculty, on-campus staff and student housing, night & weekend campus security, 24-hour
dormitory & facilities maintenance, complete food service meal plan.

“Foundations for Life” Curriculum & Resources

Textbooks, reference books, education supplies, manuals written by Burchfield Ministries for the exclusive use of
T.B.I. students, handouts, classroom supplies, career counseling.

Ministry Training
“Hands-on” ministry training through the hosting of numerous Country Camp weekend retreats which include
nationally known guest speakers at our Men’s Advances, National Women’s Retreats, Youth and Kid’s Retreats,
Prayer Culture, and much more.

First Aid Assistance

First response medical assistance are able to perform treatment of minor on-campus injuries.

Student Activities
Intramural sports activities, monthly campus-wide events and weekend student activities.

Dormitory Maintenance
An in-house team of professionals maintain all campus buildings 24 hours per day. The TBI campus has been
recognized as exemplary by The Texas State Department of Health for over 20 years.

Church Transportation
Complimentary Monday shuttle services to Columbus Wal-mart, HEB, and fast food restaurants.

Life Skills Training

Goal setting, time management, conflict resolution, developing a strong work ethic and developing basic life skills
are a significant part of each TBI Program.

MAILING ADDRESS: P.O. BOX 100, COLUMBUS, TX 78934 OFFICE: (888) 333-2824 FAX: (888) 519-5756 WWW.TEXASBIBLEINSTITUTE.ORG