Indicates required field Name Name Last Name First Name Middle Initial BSU Student ID Number or Social Security Number Permanent Mailing Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Date of Birth Home Phone Office Phone Beginning Term - Select -FallSpringSummer ISummer II College Major Expected College Graduation Year High School High School High School Name Graduation Date College Hours Completed (If any) Other Colleges Attended (if any) Are you applying as a West Virginia Resident? Yes No Are you applying as a Border County Resident? Yes No SCHOLARSHIP CRITERIA Dependents of full-time, permanent faculty, classified, and non-classified staff. Student must remain in Academic Good Standing for renewal. Employee Name Employee First Name Employee Last Name Location of employment Relationship to Employee Signature The information provided on this application form is true and correct, to the best of my knowledge. I authorize Bluefield State University to access my student records. In addition, if awarded, I grant permission to BSU personnel to release information on my academic progress to donors Sign below Date CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.