Declaration to Enroll at Batten University

I hereby declare my intention to enroll at Batten University upon the completion of my Virginia Community College System Associate of Arts or Associate of Science degree.

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Student Information

First Name

Last Name

Street Address

City

State

ZIP Code

Preferred Phone Number

Email Address

Community College Information

I am currently enrolled at

Student ID Number

Current Academic Program

Batten University Information

I intend to begin coursework at Batten University

Intended Major at Batten University

I hereby authorize administrative personnel at my community college and Batten University to exchange such personal and academic information about me as is necessary to facilitate my enrollment at Batten University.

Date