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First Name

Last Name

Birth Date

Email Address

Confirm Email Address

Mobile Phone

Home Phone

Would you like to receive text messages from BCCC?

Preferred Method of Contact

Is your Address Outside the US or Canada?YesNo

Street Address Line 1

Street Address Line 2

City

State/Province

ZIP/Postal Code

Have You Earned Your High School Diploma or GED?YesNo

Student Type

Adult Basic Education/GED Student - I plan to earn my high school diploma/GED.
English as Second Language Student - I plan to learn English as a second language and/or take citizenship classes.
Workforce Training Student - I plan to develop job readiness skills, and/or earn an industry certification or license to further my career.

Academic Program

Entry Term

Country of Birth

Do you want to be contacted by someone to answer any specific question?YesNo

Account Information

Your password must contain at least 10 characters, at least 1 number, at least 1 special character (for example: #, $, *), at least 1 uppercase letter, at least 1 lower case letter.

Password

Confirm Password

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Placement Assessment

Account Information