Benedict College - 2019 Summer Bridge Program Registration Form
Please complete and submit the form below to formally register for the Benedict College Summer Bridge Program. This program will operate during the Summer Session (Jun 29 - Aug 8). Participants must be admitted to Benedict College at the time of registration. Summer Bridge is a FULL residential program - participants are NOT permitted to leave campus during the course of the program. Participants will be enrolled in two courses (total 6 credit hours). Upon submitting the registration form, the Summer Bridge Office will contact you to discuss program logistics and course selection. You may direct questions to this office at (803) 705-4110 or by email Summer.Bridge@Benedict.edu.

By submitting this form, you agree that you have reviewed this information and you certify that the information provided is true and accurate to the best of your knowledge. Completing the Summer Bridge Registration form means you have agreed to participate in and pay all fees associated with the Summer Bridge Program.

Full Name: *
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Mailing Address: *
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Email Address: *
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Gender Identity: *
Phone #: *
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Date of Birth: *
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Benedict College Admittance Status: *
Have you paid the $150 Housing and Enrollment fee?
Benedict Student ID#:
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Are you Pell eligible? *
What is your intended academic major? Check one. *
Required
Parent/Guardian Name: *
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Parent Address: *
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Parent Email Address: *
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Parent Preferred Contact #: *
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Emergency Contact Name: *
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Emergency Contact Address: *
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Emergency Contact Relationship: *
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Emergency Contact Phone #: *
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Check the following option(s) that best describes your housing preference. *
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Do you have health insurance? (policy information must be shared with the Health Center)
Please list any dietary preferences: *
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Please indicate any dis/abilities that require technical accommodations (e.g. blindness, deafness, ADHD). *
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