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Birmingham-Southern College
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Confirmation of Intent to Enroll
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We are pleased to confirm your acceptance for admission to Birmingham-Southern College. I hereby confirm my intent to enroll at Birmingham-Southern College for the:
Fall
Winter
Spring
Summer
As a:
Freshman
Sophomore
Junior
Senior
Special Student
Name and Contact Information
Please enter/confirm the information below so that our records are as up to date as possible.
Salutation
Dr.
Hon.
Mr.
Mrs.
Ms.
Rev.
First Name
Middle Name
Last Name
Email Address
Home Phone
Mobile Phone
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Additional Information
Birthdate
Birthdate
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1901
1900
Social Security Number
Marital Status
Single
Married
Divorced
Widowed
If married, Spouse's Name
T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Last School Attended
School Name
City
State
Parent Information
Father/Guardian's Full Name
Email Address
Home Phone
Mobile Phone
Employer and Job Title
Mother/Guardian's Full Name
Email Address
Home Phone
Mobile Phone
Employer and Job Title
Legacy Information - Please give names and relationships of relatives who have attended BSC.
Number of Relatives
0
1
2
3
Name
Relationship
Dates of Attendance
Name
Relationship
Dates of Attendance
Name
Relationship
Dates of Attendance
**PLEASE SUBMIT A COPY OF YOUR DRIVER'S LICENSE WITH THIS FORM FOR NAME VERIFICATION**
If you are unmarried and plan to live off-campus, please indicate below the relative with whom you plan to live.
Name
Relationship
Phone Number
Birmingham Area Address
Birmingham Area Address
Country
Street
City
Region
Postal Code
I understand that my acceptance to Birmingham-Southern College is conditional and is contingent upon my successful completion of high school. BSC also reserves the right to rescind the admission of any student found in violation of either the College’s Honor or Social Conduct Code prior to their arrival as a full-time student.
Signature
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
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2025
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2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Congratulations on your decision to attend BSC! We look forward to welcoming you to the Hilltop. If you have any questions, please call the Office of Admission at (205) 226-4696.
Submit