Admission Application


Please fill out and submit this using the button at the bottom.


Or if you prefer, you may print this file and send your application to:

Lutheran Bible Institute
5321 University Drive, Suite G
Irvine, CA 92612
(949) 262-9222
Fax: 949-262-0283
E-mail: Constance.Sorenson@lbic.org



Please Fill Out All Fields
# Information User
1 Social Security Number:
2 First Name:
  Middle Name:
  Last Name:
  Name Suffix: Mr. Mrs. Ms. Dr. Jr. Other
3 Applying Term:
4 Gender: Male Female
5 Other Names You Have Used:
  First Name:
  Middle Name:
  Last Name:
6 Birth Date (MM/DD/YYYY):
7 Age:
8 Legal Address: (Do not use P.O. Box or business address):
  Street:
  City:
  State:
  Zip:
  Country:
  I have lived at this address since (MM/DD/YYYY):
9 If you have lived at your present address fewer than two years, complete this section:
  State:
  From (MM/YYYY):
  To (MM/YYYY):
  State:
  From (MM/YYYY):
  To (MM/YYYY):
10 Mailing address (please change if different from legal address above):
  Street:
  City:
  State:
  Zip:
  Country:
11 Telephone Numbers:
  Home:
  Business:
  International/Out of U.S.A.:
  FAX (Facsimile) Number:
12 Place of Birth:
  City:
  State:
  Country:
13 Last High School Attended:
Date Last Attended (MM/YYYY):
  Attended an Orange County High School
Attended a CA High School Outside of Orange County
Out of California
Out of U.S.A.
Did not attend High School
14 Last College attended:
  Date Last Attended (MM/DD/YYYY)
  Attended a California Community College (CCC)
Attended a California State University (CSU)
Attended a University of California
California Private or Other University
Out of California
Out of U.S.A.
Did not attend College
15 My present stay in California began (MM/DD/YYYY):
16 Were you, your spouse, or your parent on fulltime active military duty or discharged during the last 12th months? No Yes
17 If you are 19 years of age or older, answer the following questions about yourself. If you are under 19 years of age, answer the question about your parent(s).  
Have you, (or if you are under 19, have either of your parents), ever registered to vote in a State OTHER than California? No
Yes
Have you, (or if you are under 19, have either of your parents), ever filed a legal action in a State OTHER than California? No
Yes
Have you, (or if you are under 19, have either of your parents), ever attended a non-California college/university as a resident of that state? No
Yes
Have you, (or if you are under 19, have either of your parents), filed as a Non-Resident for California State Income Tax purposes? No
Yes
18 Complete this question only if you are under 19 and have never been married.  
Name of Parent/Legal Guardian:
  Relationship to you: Father
Mother
Legal Guardian
Other
  This person is a: U.S. Citizen
Permanent Resident Alien
Other
  Last state of residence for this person:
  From (MM/YYYY):
  To (MM/YYYY):
19 Are you a United States Citizen? Yes
No
20 If you are not a United States Citizen, please complete visa type:  
  Permanent Resident
Temporary Resident (Amnesty)
Refugee
Student Visa (F-1 or M-1 Visa)
I-20 to be issued by Concordia University/L.B.I.
I-20 has been issued by other institution
Tourist (B-1/B-2)
Other
21 Ethnic Identity:
22 Educational goal:
23 Primary Language:
24 If English is your second Language: No
Yes
  Do you have trouble speaking English or understanding spoken English? No
Yes
  Do you have difficulty reading or writing English? No
Yes
  Do you plan to take English as a Second Language classes at another school? No
Yes
25 Educational Status:
  Year Degree was received (YYYY):
  If you are currently enrolled in K-12, enter anticipated high school graduation date (MM/DD/YYYY):
26 Enrollment Status:  
27 College units or degree completed by first day of this term:
28 Major:
29 Employer:
30 E-mail Address: