Name *

Birthdate *

E-mail *

Dorm and Room

School Address

Phone Number *

Classification

Freshman
Sophomore
Junior
Senior
Graduate Student
Law Student
Pharmacy Student

Transfer Student?

Yes
No

International Student?

Yes
No

Major *

Parents Names

Home Address *

City *

State *

Zip Code *

Home Phone Number

Church Member

Yes
No

If yes, where? *

List any area of the BSU that interest you *

I am preparing for vocational ministry

I would like someone to speak with me about a personal relationship wi

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