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:

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. *