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Information Registration

This is not an application for financial aid

Completion of this form will place the information in the Black Student Fund's database of families requesting information about our Financial Aid program and Member School referral service. This is not an application for financial aid. The information you provide will be kept confidential and will enable the Fund to serve you better by having a basic record about you on file. Your name will also be placed on our mailing list for notices about upcoming BSF events.

Please note: This form uses electronic mail to send the information you provide to us. In order for the form to be processed, your computer must be capable of sending e-mail.

Items in bold are required.

Please provide your name and contact information:

Parent or Guardian Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
E-mail
How would you prefer to be contacted:

Child 1 Information:

Name
Date of birth
Gender Male Female

Enter the current school attending:   

Enter current grade level:       

Child 2 Information:

Name
Date of birth
Gender Male Female

Enter current school attending:   

Enter current grade level:    

Child 3 Information:

Name
Date of birth
Gender Male Female

Enter current school attending:

Enter current grade level   


Comments:

What is your annual household income? 

How did your learn about the BSF web site?

Copyright 1998. Black Student Fund. All rights reserved.
Last revised: November 15, 2007