BELHAVEN STUDENT REFERRAL FORM

Thank you for referring prospective students to Belhaven University! By filling out this form, you are giving the gift of opportunity to your family and friends and helping fulfill the mission of our university - to prepare students academically and spiritually to serve Christ Jesus in their careers, relationships, and the world of ideas. Referred students will be contacted by our Admissions Office about the possibility of attending BU.

Your Information:
We would love to thank you for helping Belhaven’s recruitment efforts!

Your First Name:	*
Your Last Name:	*
Your Email Address:	*
Your Phone Number:	*
Your Street Address:
Your Address Cont:
Your City:
Your State:
Your Zip:
Your Relationship to Belhaven:	*
How do you know this student?:

Student Information:

First Name:	*
Last Name:	*
Phone Number:	*
Email:	*
Street Address:
Address Cont:
City:
State:
Zip:
Which of our programs would you recommend for this student?	Traditional (for students ages 18-22) Adult/Graduate Online Dual Enrollment (for high school students) *
Can we tell the student you referred them?	Yes No *

* Indicates Required Field

Thank you again for helping advance the mission of Belhaven!