BHCC Online Application

School Year*

First Name*

Middle Name

Last Name*

Street Address*

City*

Zip Code*

e-mail address*

Birthdate*

Birthplace City*

Parent Name*

Parent Phone*

Parent Email Address*

Home School*

Present Grade*

First Program Choice*

Second Program Choice*

If outside of the area, enter current school

Why do you want to take this program?