Institute for Biblical Counseling & Discipleship
5333 Lake Murray Boulevard • La Mesa, CA 91942
(619) 462-9775
 Application for Enrollment

PRINT OUT FORM AND COMPLETE.

Date: __________________
Name _____________________________________________Home Phone ________________
Address____________________________________________Work Phone_________________
City ______________________________________ State ________________Zip ___________
E-mail address ______________________________
Home Church_______________________________________Church Phone________________
Pastor________________________Church Address____________________________________
Are you a member?_____Year of Membership____Denomination__________________________
List ministries you are involved with in your church:
_____________________________________________________________________________
_____________________________________________________________________________
How do you plan to use this training?
_____________________________________________________________________________
_____________________________________________________________________________
How did you hear about IBCD?______________________________________________________
Do you plan to take the courses in person or by tape?_____________________________________
On what level do you wish to enroll: Audit, Basic, Certificate? (See page 6 of Education Catalog.)
____________________________________________________________________________
If you are taking all four courses in January, do you need information on a payment plan?_________

Please give a brief testimony of your Christian faith:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
(Continue on back, if you wish.)

 
To register:
  1. Print out and complete this application. Mail it to IBCD, 5333 Lake Murray Blvd, La Mesa, CA 91942.
  2. If you plan to take the course for credit, ask your pastor or elder to write a letter of recommendation stating your suitability for enrollment in this course, and send that with your application.
  3. If you will be attending the class, include a check for the registration fee of $50.00, which will be deducted from the audit tuition. (Tuition is not refundable after the class begins.)
    If you are taking the class by tape, send a check for the cost of the video or audio tapes, plus $5.00 for shipping (plus application and letter of recommendation, if taking it for credit).
  4. If you are taking the class for credit, after you attend the class or watch the tapes, do the homework and mail it to us with a check for the credit fee ($110 for each class except Marriage & Family, which is $165).
    If you have any questions, please call us at (619)462-9775.