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MOODY UNDERGRADUATE SCHOOL Matriculation Deposit Form We hope that you will accept our offer to join us as a student in the Undergraduate School. To confirm your intention to enroll, you must submit a matriculation of $350 with this form. We must receive it in the Admissions office no later than the specified due date in your acceptance letter. Late deposit may result in forfeiture of admission. The amount will be credited to your first semester’s school bill. Should you decide not to enroll after submitting the deposit, the deposit is not refundable. If you have questions regarding the deposit or would like to pay by credit card, you may call the Admissions Office at 800-9674624. Student’s Full Name________________________________________________________ MBI ID#_____________ Address _______________________________________________________________________________________ City_________________________________________________ State_________________ Zip________________ E-Mail _______________________________________________________________________________________ Phone Number _________________________________________________________________________________ Enrolling for location (circle one) MBI Spokane If you choose Spokane, circle a program or First Year Online - BA in Biblical Language - BA in Biblical Studies - BA in Youth Ministry - BA in Intercultural Ministries - BA in TESOL -BA in Biblical Exposition-Interdisciplinary The amount of $ _______________ is enclosed in the form of (circle one) check money order It is understood that should I decide not to enroll at Moody, the matriculation deposit is not refundable. Student’s Signature__________________________________________________Date_____________________ Cancellation of Admission I wish to cancel my admission to Moody Bible Institute at this time. I understand that I am free to seek admission in the future. Signature______________________________________________________Date_________________________ If you are canceling your admission, please complete the following: Attending a secular college/university Not enough financial aid Better program elsewhere Other___________________________________ Attending another Christian college/university Received more financial aid elsewhere Change of plans Please return this form to: Admissions Office, Moody Bible Institute, 820 N LaSalle Blvd, Chicago IL 60610 MBI Spokane or FYOP