Student Referral Form

Use this form to recommend a prospective student to Valparaiso University. We'll take care of the rest. E-mail us with questions or comments at admissions.network@valpo.edu.
Student Information
First Name:		Middle Initial:		Last Name:
Street:
City:		State:		Zip:
or Country, if other than USA:
Parent/Guardian Name(s):
High School Name:
City:			State:
Student's Email:			Year of Graduation:
Student's Phone:	- -
Academic/career interests (if known):

Activities/sports (if known):

Ethnic Background (optional):
No Answer African American Asian/Pacific Islander Caucasian Hispanic/Latino Native American Other
Referred By:
First Name:		Middle Initial:		Last Name:
Street:
City:		State:		Zip:
or Country, if other than USA
Phone:	- -			Class of:
Email:
Relationship to Student:
Write other comments below. If you do not know the student personally, tell us how you learned of him/her.

VAN