Alumni Referral Form

Do you know a prospective student who would be a perfect match for Belhaven University?  Just fill out as much information as possible about the student and our Admission office staff will make contact with him/her about the possibility of attending BU.  Thank you for helping spread the word about your alma mater and building future Blazers!

Student’s Information:
 
First Name: *
Last Name: *
Relation to Prospective Student:  *
Program of Interest: Traditional (18-22 year olds)
Online Program
Adult Evening Completion
Home School - High Scholar *
Phone: *
E-Mail: *
Street Address:
Address Cont:
City:
State:
Zip:
Additional Comments:

In order to maintain the accuracy of our records, please provide us with the following information.

Alumni Information:
 
First Name: *
Last Name: *
E-Mail: *
Phone Number: *
Street Address:
Address Cont:
City:
State:
Zip:
Enter the numerical value of ten minus three. *
* Indicates Required Field