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Black Student Union Membership Application
Please fill out this form as accurately as possible. No membership dues are required. If you have any questions regarding membership email
umissbsu@gmail.com
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* Indicates required question
Email
*
Your email
Name
*
Ex. Nekkita Beans
Your answer
University Email Address
*
Ex:
nsbeans@go.olemiss.edu
NOT
nsbeans@yahoo.com
Your answer
Phone Number
*
Ex: (601) 555-8386
Your answer
Hometown (City, State)
Your answer
Classification
*
Freshman
Sophomore
Junior
Senior
Super Senior
Are you a Transfer Student?
Yes
No
Clear selection
Major(s)
Your answer
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