College Admissions Form

Blue Mountain Christian University

201 W. Main St. Blue Mountain, MS, 38610

admissions@bmc.edu

www.bmc.edu

(662) 685-4771
Undergraduate admissions application

Enter your admission information below
Name*

First NameMiddle/Maiden NameLast Name
Preferred Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Cell Phone Number*
Home Phone Number*
Please enter a valid phone number.
E-mail Address*
example@example.com
E-Mail Address*
Age:*
Mailing Address*

Address 1

Address 2

CityState / Province

Postal / Zip Code
County:
Emergency Contact*

First NameLast Name
Relationship*
Email*
example@example.com
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Do you speak any languages other than English?*

YesNo
Please list them

Agree and Submit:

Blue Mountain Christian University does not discriminate on the basis of race, color, national origin, sex (including pregnancy), age, disability, military service, or genetic information in its programs, activities, and employment. Further, the College does not retaliate against a person because he/she complained about discrimination, filed a charge of discrimination or participated in an employment investigation or lawsuit. BMC prohibits harassment because of a person's race, color, national origin, sex, age, genetic information or religion. The College may discriminate on the basis of religion in employment as it deems it is prudent to do so in order to achieve its mission.

Blue Mountain Christian (BMC) was founded on Christian principles and those same Christian principles continue to guide the College today. Each student enrolled at BMC is responsible for personal conduct in keeping with the policies and regulations of BMC.

By clicking I Agree below, I confirm that the information provided on this form is correct and complete and also confirm my willingness to abide by the policies and regulations of BMC.
Agree & Submit:*

I agree to the wavier above
Should be Empty: