7245 College St. Lima, NY 14485
Main Phone» 585.582.1230
Admissions» 1.800.670.ELIM

Online Application

Step 1
Personal Information

Step 2
Education and Church Information

Step 3
Employment and Financial Information

Step 4
Health Information and Interests

Step 5
Personal Statment

Married Student
International Students

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* Indicates a required field

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*Please type your full name here for ID purposes:

Health Information:

Please Note: Upon receipt of your application, the Admissions office will send you a Health Report to be completed in compliance with New York State law.

Do you have physical or learning disabilities?

If yes describe:

Interests, Activitites & Experience:

Choose the number of years that you have been involved in each activity:

	Yearbook staff		Church volunteer
	Drama team		Youth group office
	Choir		Sunday School teacher
	Band/Orchestra		Bible teacher
	Student Council member		Home group leader
	Church elder/deacon		Community service projects (list)
	Missionary service

List other interests or hobbies:

How did you first learn about Elim Bible Institute?

Description of "Other" (above) or Student's Name:

References:

List the name, complete address, and telephone number of your senior pastor, church leader (elder, deacon, Sunday School superintendent, youth director, etc.), and a non-church related teacher (an employer may be substituted if you have not attended school or college in over a year). None of your references should be related to you. If your parent is the senior pastor of your home church, an elder or church officer may act as the pastoral reference for you.

	Senior Pastor
Name:
Address:

Phone:

	Church Leader
Name:
Address:

Phone:

	Teacher or Employer
Name:
Address:

Phone:

Ask each of your references to complete a Personal Reference Form (downloadable from this website) and have them return it to the Director of Admissions, Elim Bible Institute, 7245 College Street, Lima, NY 14485.

WAIVER OF ACCESS: The Family Rights and Privacy Act of 1974 provides the student the right to review all materials placed in his/her personal file after January 1, 1975, if admitted as a student. You may wish to waive the right to see the character references that are provided with the understanding that you will not see them. Check the box below which represents your wishes. This will in no way affect the decision of the Admissions Committee. The persons furnishing the references will be informed of your choice by the information you provide in the applicant's section of the Personal Reference Form. You must indicate the same choice below as you do on your Reference Forms. Please note: We expect you to indicate your choice regarding the Waiver of Access. If no choice is indicated, we will be unable to process your application.

	I waive my right to see my character references under the provisions of the Family Rights and Privacy Act of 1974.
	I do not waive my right to see my character references under the provisions of the Family Rights and Privacy Act of 1974.

If accepted, I agree to abide by the rules of Elim Bible Institute.*

Full name of applicant:

Date of Application (Mo./Day/Yr.):

*A paper copy of this statement will also be sent to you once you submit your application. Please sign and date your agreement and return to the Elim Admissions office.