Student Referral Form

Would you like to make a referral?  Here's your chance.

Admissions Student Referral Form

Please complete the form below to refer a potential student to Landmark College.

Information About You

Your First Name*

Your Last Name*

Your email address*

Phone*

Your relationship to student being referred*

Are you a current LC student, alumnus, or parent?

•   Current LC student
•   Parent
•   LC alumnus
•   None of the above

Information About Student Being Referred

Student's first name*

Student's last name*

Student's Email

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Year and Semester of interest?

Spring 2019 Summer 2019 Fall 2019 Spring 2020 Summer 2020 Fall 2020

Comments

European Union's General Data Protection Regulation (GDPR)

As we make every effort to comply with the EU's GDPR, please answer the following questions:

Are you currently in or a resident of an EU country?

•    Yes
•    No

May we contact you?

•    Yes
•    No

Contact preference (select all that apply)

•   email
•   phone
•   text
•   social media