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Bethel College Prospective Student Referral Form

for first-time freshmen and transfer students from U.S.

Thank you for recommending a student you think would benefit from attending Bethel College during the 2012-13 academic year. The fields marked with an asterisk (*) are required.

Your Information
First name*:
Last name*:
Middle name:
E-mail*:
Student ID #*:
Prospective Student Information
Enrollment Type*:
Gender:
Male Female
Expected Term*:
Year*:
Prospective Student's Name
First name*:
Last name*:
Middle name:
Preferred name (if different from first name):
Address
Street or P.O.Box*:
City*:
State*:
ZIP*:
Telephone/e-mail
Home phone*:
Cell phone:
E-mail*:
Academic information
High school*:
Year of graduation*:
Transfer Students Only:
College/University attending/attended:
Dates Attending/Attended: