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
Last
Street Address
City
Zip
Phone #
Email


High School
Graduation Year

Career Interests (if known)


Referred By

First
Last
Street Address
City
Zip
Email
Check here if you are an alumnus/a of Valparaiso University

Relationship to Student


Write other comments below, including referral rationale.
If you do not know the student personally, tell us how you learned of him/her.