Early College Application

Indicates required field

Student Name
Last Name First Name Middle Initial

Phone

Date of Birth

Gender

Email Address

Address

City/Town

State/Province

ZIP/Postal Code

County

Current High School

Graduation Year

	Ethnicity
African American	African American
American Indian or Alaskan Native	American Indian or Alaskan Native
Asian	Asian
White	White
Native Hawaiian or Other Pacific Islander	Native Hawaiian or Other Pacific Islander

Are you Hispanic/Latino?

Yes

Are you a first generation college student (your parent(s)/guardian(s) did not attend college)?

Yes

Do you have a family member who attended or graduated from Bluefield State University?

Yes

Relationship

Year Graduated

Semester

Fall Semester (August-November)

Spring Semester (January-April)

Are you on a pathway for any of the following programs after you graduate high school?

Education

Are you in the Grow Your Own program?

Health Professions (i.e., Nursing, Rad Tech, Respiratory Therapy, Sonography)

STEM (Science, Technology, Engineering, Mathematics)

(Students on one of these pathways will receive a full scholarship for dual credit courses. Students who are not on one of these pathways will be charged $25 per credit hour.)

Course(s) in which you wish to enroll

Disclosures

By providing your cellular telephone number, you agree to receive text-based communication from Bluefield State University, the West Virginia High Education Policy Commission, and College for West Virginia (CFWV). Your information will not be shared with institutions other than those to which you have shown interest, nor will your information be shared with or sold to vendors or other third-party agencies. Standard text-messaging rates may apply, and you are responsible for any costs incurred while receiving texts. You may opt-out at any time by replying with the word, “STOP.”

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.

Date

Signature

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