Special Student Application

Indicates required field

Student Name
Last Name First Name Middle Initial

Phone

Date of Birth

Gender

Address

City/Town

State/Province

ZIP/Postal Code

County

Email Address

What high school did you graduate from?

Name of School	Year	Operations
Name of School	Year

Did you graduate from college?

College
College Name 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?

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

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

Relationship

Year Graduated

Semester wanting to attend

Course(s) in which you wish to enroll

CRN#	Class	Operations
CRN#	Class

more items

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.

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.

Date

Signature

Sign above

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.