Student Information
First (Given) Name:
Last (Family) Name:
Middle Initial:
Date of Birth:
Mailing Address
Address Line 1:
Address Line 2:
ZIP Code:
Phone and Email
Primary Phone:
Secondary Phone:
Confirm Email:
Parent Email:
Confirm Parent Email:
Your intended plan of study at Drexel at BCC
Program or Major:
Full-time or Part-time:
Term You Plan to Start:

* If you are interested in programs at the Main Campus in Philadelphia, please
visit the Undergraduate Contact Drexel Page to request more information.
High School Information
Add the most recent high school that you have attended.
Expected Graduation Date/ Graduation Date:
Previous/Current College or University
Add the most recent college/university that you have attended.
Attended From:
Attended To:
Why Drexel?
Which of the following led you to consider Drexel in your educational search?
Questions or Comments
Do you have any additional questions or comments?