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Prospective Inquiry Form
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For additional information please contact:

Dotti Pursley, Director of Recruitment: (609) 894-9311 Ext. 1310
Joshua Hoftiezer, College Enrollment Recruiter: (609) 894-9311 Ext. 1609


Full Name:*
Email Address:*
Address:*
City:*
State:*		Zip Code:*
Telephone Number:*
High School:*
Graduation Year:*
Prospective BCC Major:*
Place of Employment:

Have you completed a BCC Application before?*
Yes No	If Yes, Year Applied:
Are you interested in:*
Credit Courses
Non-Credit (Community Enrichment)
Professional Development
Would you like to schedule an appointment with a Recruitment Advisor?*
Yes No
Are you interested in receiving information on Upcoming Events?*
Yes No

BCC is Going GREEN! If you are interested in having any of the digital information listed below emailed to you, please check all that apply.

BCC College Catalog	Health Information Technology Brochure
Fall Semester Course Brochure	Dental Hygiene Brochure
Spring Semester Course Brochure	Sonography Brochure
Summer Semester Course Brochure	Financial Aid Information
Nursing Brochure	International Student Packet
Radiography Brochure

Please specify any other information you are interested in receiving :

*indicates a required field

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