Student 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 contact him/her to explore how they can benefit from a Belhaven degree. Thank you for helping us give the gift of opportunity to your family and friends.

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: *
Additional Comments:

Thank you for taking the time to refer a student to Belhaven. We will be in contact with him/her soon.

Your Information:
First Name: *
Last Name: *
Phone Number:
Enter the numerical value of ten minus three. *
* Indicates Required Field