Non-Degree Application - Bushnell University

Name*

Legal First Name Legal Last Name

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Country of Citizenship*

Preferred Phone*

Preferred Number Type*

Text okay?

Email*

Date of Birth*

Gender*

Are you Hispanic or Latino

Please check all that apply

High School Attended:*

Date of High School Graduation:*

Colleges/Universities Attended (if applicable):

Expected Entry Term:

When do you plan to start courses at Bushnell University?

What course(s) would you like to register for?

Please know what courses you want to take and when they are offered. You can view Bushnell’s course offering at bushnell.edu/academics/.

Signature*

By typing your name, you agree that the information listed on this application is true and complete.

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Phone

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