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C.H.A.M.P.S. Registration Form
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* Indicates required question
*Disclaimer: Students who are enrolled in EOF, TRIO SSS, and McNair are ineligible for the C.H.A.M.P.S. Program*
Name (Last, First, Middle Initial)
*
Your answer
Student ID
*
Your answer
Home Address
*
Your answer
City, State, Zip
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Primary BC Campus Address
*
(N/A if Commuter)
Your answer
BC Email Address
*
Your answer
Alternate Email Address
Your answer
Cell Phone Number
*
Your answer
Preferred Contact Method
*
Email
Text
Phone Call
Required
Gender
*
Male
Female
Non-Binary
I prefer not to answer
I prefer to self describe
Race or Ethnicity (Check all that apply)
*
American Indian/ Alaskan Native
Black or African American
Asian
Native Hawaiian/ Pacific Islander
White
Hispanic/Latino
Required
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Are you currently enrolled at BC or accepted for enrollment in the next academic term?
*
Yes
No
Year
*
First-Year
Second-Year
Third-Year
Fourth-Year
College Plan
*
Plan to Graduate from Bloomfield College
Plan to Transfer
College Major/Minor(s)
*
Your answer
Which of the following best describes your educational status
*
Check all that apply
Received a high school diploma
Received college-level credit in high school
Received a GED
Transferred from a community college with an Associate's Degree
Transferred from a community college with no Associate's Degree
Transferred from a four-year college
Required
Are you currently facing any of the following extenuating circumstances
*
Check all that apply
Work over 20 hours a week and attend school full time
Significant family responsibilities (children, care for a relative, etc.)
Significant financial responsibilities outside of school
Current foster care youth/under guardianship
Need assistance with Meal Plan
Need assistance with transportation to campus
Need assistance with on-campus housing
N/A
Required
Are you a First Generation College student?
*
Yes
No
Personal Statement (Optional)
Please write a short statement about your educational goals and career aspirations. In your statement please also tell us about the services or support you may need in order to achieve academic success and/or graduate
Your answer
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