International Student Special Application

Indicates required field

Name

First

Middle

Last

Cell Phone Number

Home Phone

Country of Citizenship

Date of Birth

Gender

Male

Female

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Confirm email

High School

Prior Colleges

Ethnicity(Check all that apply)

African American

American Indian or Alaskan Native

Asian

White

Native Hawaiian or Other Pacific Islander

Are you Hispanic/Latino?

Yes

Semester Wanting to Enroll In

Fall Semester (August)

Spring Semester (January)

Course(s) in which you wish to enroll

Disclosures
*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.

Do You Accept the Terms?

Yes

Initial

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.

Current Date

Signature

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