Refer a Student

Refer a Prospective Student

Please complete the first section of the form below with your information and the second section with the information about the student you wish to refer to Wesley College.

Your Information
Name
First Last
Maiden Name
Class Year
Email
Confirm Email
Home Phone Number
Student Information
Full Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number
Cell Phone Number
Email Address
This student is a
- High School Student Potential College Transfer Student
- Non-traditional Student/Adult Learner
- Potential Graduate Student
- Other
If other (please describe)
Name of current or last school attended
First Last
Student's high school graduation year or year undergraduate degree was received (if grad student)
Student would be interested in: (Use Ctrl or Shift keys to multi-select.)
Please provide any additional comments about this student referral:
Name
This field is for validation purposes and should be left unchanged.

Refer a Prospective Student

Your Information

Student Information