Elementary Education Alternative Certification Name(Required) First Middle Last Phone Type(Required)HomeOfficeCellPhone(Required)Social Security Number(Required) Date of Birth(Required) MM slash DD slash YYYY Gender(Required)MaleFemaleOtherAddress(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(Required) Email Address(Required) What high school did you graduate from?(Required) Year of High School Graduation(Required) Did you graduate from college?(Required)YesNoCollege Name(Required) Year of College Graduation(Required) Ethnicity(Required) African American American Indian or Alaskan Native Asian White Native Hawaiian or Other Pacific Islander Are you Hispanic/Latino?(Required)YesNoAre you a first generation college student (your parent(s)/guardian(s) did not attend college)?(Required)YesNoDo you have a family member who attended or graduated from Bluefield State University?(Required)YesNoRelationship(Required) Year Graduated(Required) Semester wanting to attend(Required)Fall Semester (August)Spring Semester (January)Winter Intersession (November)Course(s) in which you wish to enroll(Required)CRN#Class Add RemoveDisclosures I agree*By providing your cell phone number, you agree to receive text-based communication from Bluefield State University and from the West Virginia Higher Education Policy Commission and the West Virginia Council for Community and Technical College Education, otherwise known as the College Foundation of West Virginia (CFWV). You may also opt-out at any time by replying to any text sent.Your Initials for Disclosures Signature(Required)I declare that the information I have supplied on this application is complete, truthful, and correct and authorize BSU to verify the information given on this application. TweetShareShare