Refer a Student

WIth the student's permission, please share their information with us so that we may contact them. If your student is attending out of state, we can still help them connect with a campus ministry. Thank you!

First Name

Last Name

Preferred Name

Email Address

Mobile Number

College or University they are attending

Mailing Address

Mailing City

Mailing Zip Code

Home Congregation ( name, city, denomination)

Name of the person referring student

Referrer's contact information ( phone/email)

How do you know the student you are referring?

Other information you want to share