Request to Return to BLC

Planning to return to BLC after an absence? Please fill out this form to let us know!

Name Name First Last
Email
Phone
Your Bethany ID number is usually 6 digits and can be found on the back of your Bethany Student ID. If you don't know your number, enter 0.
Bethany ID Number
Must be a number less than or equal to 999999.
Other Colleges or Universities Attended
Please list any other colleges or universities attended since your last semester at Bethany Lutheran College:
My reasons for returning to Bethany Lutheran College are …
My plan for successfully completing graduation requirements at Bethany is …
Academic Success Program
By signing here, I, the above-named student, acknowledge that upon approval to return to Bethany Lutheran College I agree to participate in Bethany Lutheran College’s Academic Success Program.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.