VIMSIA Virtual Visit

Required fields are marked with an asterisk (*)

I am a:

Staff Username

Student First Name

Student Last Name

Student Email

Student Email (confirmation)

Counselor First Name

Counselor Last Name

Counselor Email

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Birthdate

Anticipated Semester of Entry

Student Type

Mailing Address*

Country

Street

City

Region

Postal Code

How did you hear about Bentley?

Do you have time for a few more questions? (optional)

Yes

Not at this time

Other Personal Information

Student Academic Interest

School Name

Student Citizenship

Are you Hispanic/Latino?

Yes

No

Student Sex

Student Gender

Student Phone - Mobile

Student Phone - Home

By providing your mobile number, you are agreeing to receive SMS messaging from Bentley University. Standard rates may apply.

Parent/Guardian Information

Relationship to Student

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Mobile Phone

Undergraduate Admission