VBC Enrollment Application

Only NEW students need to fill out this enrollment application. Additionally, a copy of your High School Diploma and/or GED is required as well as transcripts from previously attended colleges or universities. If you are a returning student or just looking to audit classes, you may proceed to registering for classes https://myfwc.breezechms.com/form/vbcclassregistration

Personal Information

Name

This address will receive a confirmation email

Mobile Phone

Secondary Phone

Address

Birthdate

Education Information

You will need to provide a copy of your High School diploma and/or GED as well as transcripts from previously attended colleges or universities. You can email documents to info@vbc-wa.org. or our
mailing address is
P.O. Box 1122
Port Orchard, WA 98366

High School

Diploma GED

List any colleges you have attended and the years you attended

Do you hold any college degrees and/or certificates?

Yes No

Please list any degrees and/or certificates you hold and where you earned them from.

Employment

Are you currently employed?

Yes No

Name of Employer

Job Title

Supervisor's Name

Supervisor's Phone

References

Reference 1 Name

Company

Relationship to you

Address

Phone

Reference 2 Name

Company

Relationship to you

Address

Phone

Reference 3 Name

Company

Relationship to you

Address

Phone

Payment Information

The application fee is $25 plus a 3% processing fee.

Application Fee $25.75

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

VBC Enrollment Application

Description

Please Fix the Following