Student Referral Form for Alumni, Friends, and Family

I am a (select all that apply): *

Alum

Hampshire Parent

Friend of the College/Other

Would you like to recommend a student for the Alumni Recognition Award? *

Yes

No

Your Information

An asterisk (*) indicates a required field

Your First Name *

Your Last Name *

Your Email Address *

Your Cell Phone: *

Your Address:

Country

Street

City

Region

Postal Code

Alum Entering Year (ex: 2017F)

Student Information

Student First Name *

Student Middle Name

Student Last Name *

Student Preferred First Name

Student Date of Birth

This student would apply as a: *

First Year

Non-Degree

Transfer

Intended Entry Term *

Fall 2022

Fall 2023

Spring 2022

Spring 2023

Email Address *

Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Most Recent School Attended

Most Recent School CEEB

Tell us a bit about this student: *