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Emerging Scholars Academy Application

Personal Information

Name(Required)
Date
Sex
Address
Email(Required)
Education Completed

Parent / Guardian

Name
Address
Emergency Contact Name

Notice of Disclosure – Confidentiality and Use of Personal Data

Bluefield State University gathers, generates and stores information concerning its prospective students. Bluefield State University is committed to the protection of privacy and confidentiality of all its students. The purpose of this data collection is directly related to and needed by Bluefield State University to administer the university/prospective student relationship including the proper recording of student academic progress and to adhere to grant reporting requirements.

Data collected on this form will be disclosed and used as follows:

  • Registrarial, administrative and academic offices for record-keeping, institutional analysis, provision of services to students, academic integrity enforcement; academic counselling and advising offices for advising services; where the operational necessity of the University requires the disclosure;
  • Research and Sponsored Program’s and Office of Institutional Assessment for statistical analysis and planning purposes; student associations and societies for services to students; Academic Student Center for the administration of activities including co-op programs, counseling services and residence administration; Alumni Association for services to alumni; financial aid, scholarship and award determination;
  • Student Health Services for health services.

If you have any questions about the collection, use, and disclosure of this information please contact the Alumni Affairs Office at dguyton@bluefieldstate.edu

I agree to the terms outlined in this Application Form.

I declare that the information disclosed on this Application Form is accurate and true.