Application for Dual Enrollment Admission
Continuing Education and External Programs
Thurgood Marshall Library, Room 1128
14000 Jericho Park Road
Bowie, Maryland 20715-9465
Phone: 301-860-3991 Fax: 301-860-4081
BSU Cashier: 301-860-3495
Dual Enrollment Students are not eligible to receive Financial Aid
Please Print Information Clearly
Non-refundable Application Fee $17.00 - Payment of Fees For Classes Is Due At The Time Of Registration.
Section I: General Information
Social Security Number: BSU Student Identification Number:
Last First M.I. Maiden/Former Name
Street City State Zip County - Country
Please check and sign if you want to change the address BSU currently has on file. Signature:
Work/Daytime Telephone: Home/Evening Telephone:
Cell Phone Number:
Section II: Personal Information
The University is required by Federal, state and local governments to supply admission and enrollment information. This information
is not used as a factor in determining eligibility for admissions.
Birth Date: / / Gender: Female
Please answer both questions regarding race/ethnicity:
Are you of Hispanic or Latino origin? Yes No
What is your race? Select one or more of the following categories, as appropriate.
White American Indian or Alaska Native Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American: A person having origins in any of the black racial groups of Africa.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central
America) who maintains cultural identification through tribal affiliation or community attachment.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific
National Origin (Check only one):
United State Citizen: Non-United States Citizen, please complete the following: _ _
Country of Citizenship: Type of U.S. Visa:
Sponsored by: If permanent resident, U.S. alien registration number:
Date of Issuance:
(A photocopy of the front and back of your permanent resident card is required)
Person to contact in case of an emergency:
Telephone: Relationship to Applicant:
High School Diploma-Date
GED – Date:
Bachelor’s Degree – Date
Are you currently enrolled in a degree program at another College/University? Yes No If yes, where:
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