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STUDENT REFERRAL FORM
The Admissions Office is eager to learn of possible future Beloiters who are in the midst of the college search process. Alumni, parents, and friends of the College are often our best advocates. By talking with prospective students and their families about the outstanding opportunities available here, you help to shape the future of Beloit College.

Please open the door to the Beloit College experience for your child, or a special student you know, by completing this form:
Student Information
 (fields marked with an asterisk (*) are necessary to process your referral)
 
First Name*:
Last Name*:
Gender:
Male Female
Street Address1*:
Street Address2:
City*:
State*:
Zip* :
Country:
Home phone:
Cell phone:
Email address:
 @
HS Grad. Year*:
High School or College*:
Student Type*:


Academic Interests:
Extra-curricular Interests:
Comments:
 
Referrer's Information
(fields marked with an asterisk (*) are necessary to process your referral)
 
First Name*:
Last Name*:
Street Address1:
Street Address2:
City:
State:
Zip:
Country:
Phone number*:
Email Address:
@
Relationship to this student?

Relationship to Beloit College?(if "other" is checked, please use comments below to describe.)

 Alum - Class of:
Parent of current student or alum
Faculty/staff
Other
Comments: