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
Email

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.