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Brenham: Classroom Building, Office 19

Virtual College of Texas

Please fill out this form completely. If you do not fill it out completely, your request will be delayed.

* = Required fields

Section 1: Contact Information

Is this request for*:

Name*:

Blinn ID*:

Address*:

City, State, Zip*:

Valid Phone Number*:

Valid Email Address*:

Previous Distance Learning Experience:


Section 2: Student Status

Note: If you are not a current Blinn student, you will need to become one before I can process your request.

Are you a current Blinn Student, meaning you have attended Blinn College during the current or previous semester?

Are you graduating this semester?

If yes, where are you graduating from?


Section 3: VCT Course

Course Requested (Example: PHIL 2306, not the title of the course):

Have you looked at the VCT web site for availability?

If yes, please list your preferred college: With regard to your preferred college, we will do our best to accommodate your request. However, in some cases, another college will be picked due to fees or previous experience.