ACE and High School Dual Enrollment

Application for Admission (Category 3) - All fields required

Important - use this form ONLY if you plan to take BU courses while enrolled in high school. If you wish to enroll at Bloomsburg after you graduate from high school, see information for traditional fall freshman.

Basic Information

Last Name *

First Name *

Middle Initial

Street Address *

City *

State *

Zip *

County in which you reside *

Full Email Address - Example: myname@gmail.com *

Telephone Number *

Scheduling Information

Semester I Am Scheduling *

Year I am Scheduling *

Are you in the STEM Program? *

Yes

Emergency Information

Person to be notified in case of emergency

Last Name *

First Name *

Street Address *

City *

State *

Zip Code *

Telephone Number *

Information About You

Birth Date *

Month

Day

Year

Gender *

Male

Female

US Citizen? *

If 'no', list country of citizenship

Ethnicity

Bloomsburg University is required by the US Department of Education, Office of Civil Rights, to collect and report information pertaining to ethnic backgrounds of applicants for admission. This information will not affect the admissions decision about your application.

What is your ethnicity? *

What is your race? *

School Information

School Attending *

The districts listed are ACE partners but other districts can be added at the district's request. If your district is not listed, select "other."

Current Grade *

By Checking This Box I certify that all the information contained on this application is true and accurate *

I certify that all the information contained on this application is true and accurate.

Today's Date *

Month

Day

Year

ACE and High School Dual Enrollment

Application for Admission (Category 3) - All fields required

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