Bridge Program Application

Student's Name:


























Emergency Contact if parent/guardian is unable to be reached:




Participant Agreement

I understand that this application will reserve my spot for the Fall 2013 American Indian Bridge Program. I understand that, as a participant, I am expected to be in attendance for the entire program the week before classes begin, on the Black Hills State University campus in Spearfish, South Dakota. I also give BHSU permission to use my name and/or photos in which I may appear for future marketing or promotional materials.