GRADUATE INFORMATION SESSION
Please select a date
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Thursday, May 12, 2011 5:30 p.m. - 7:30 p.m.
First Name
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Middle Initial
Last Name
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Gender
*
Female
Male
Birthdate
Address
*
City
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State
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- - Choose One - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
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Home Number
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Work Number
Cell Number
E-mail address
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Current School/Last School Attended
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What semester and year do you wish to enroll?
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Summer 2011
Fall 2011
Academic Interest
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Counseling Psychology-- MA
Mental Health Counseling--MA
School Counseling -- MED
Family Counseling -- Certificate
Addiction Counseling--Certificate
Human Service--Certificate
Psychotherapy--Certificate
How did you hear about Open House?
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BSU Alumni
Internet
College Fair
Flyer
Friends/Family
Newspaper
Radio
Television
School Visit
Recruiter
Current Student
BSU Faculty/Staff
Other