Southern Bible College & Seminary
Tuesday, June 06, 2023


FULL NAME:  ___________________________________________________
STUDENT ID #  __________________________________
DATE ENROLLED: ______________________________
DATE FIRST ATTENDED: ________________________
CURRENT MAJOR: _______________________________________
NEW MAJOR: ____________________________________________
 ASSIGNED INSTRUCTOR:  ________________________________________
 I am picking up right where I left off in my program of studies.
 I wish to change my Program of Study ($55.00 Change of program fee). 
 I am submitting a new Payment Plan Agreement.
 I have selected Payment Plan  ($75.00 Monthly)
 I have selected Payment Plan  ($125.00 Monthly)
 I am submitting the reactivation fee of $75.00
My email, mailing address, telephone numbers, and other contact information have been updated with the school.
I am affirming my reactivation by attaching my signature below and I am in good standing with the school or I am changing my program of study to a different discipline.
STUDENT SIGNATURE  ______________________________________
DATE  _________________________________
*You will be contacted by your assigned instructor soon with further instructions.
*Print out this page, complete the form and mail it to the school.