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Bluefield State College Self Service

 

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Request for Information Form

 

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Information Please enter the requested information. Please note that an asterisk denotes required information.

Required - indicates a required field.
Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Please enter your home mailing address.

Address
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Information Please enter your personal email address.

E-Mail Address
E-mail Address:Required
Verify E-mail Address:Required

Information Please use dropdown box and select the term you wish to enter.

Entry Term
Term of Entry:Required

Information Please put a checkmark by your gender information.

Gender
Gender: Male Female Not Specified

Information Please fill out all the information on your high school. You may use the look up function if you do not know your ACT high school code.

High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Information Please select the BSC Major in which you are interested, using the dropdown box.

Prospect Major
Major:

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Release: 8.7.2