Student Referral Form

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

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Student Referral Form

Please complete this form to refer a potential student to Landmark College.

About You

First Name

Last Name

Email

Telephone

Relationship to the student being referred

Which item best describes you? Current LC studentLC alumnusParent of LC student or alumnusEducatorNone of the above

About Student Being Referred

First Name

Last Name

Email

Telephone

Street

City/Town/Municipality

State/Province/Territory SelectAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuébecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory

Postal Code

Comments

European Union's General Data Protection Regulation (GDPR)

The EU's GDPR requires we ask the following questions:

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

May we contact you? YesNo

Contact Preference

(select all that apply)

EmailPhoneTextSocial Media

Submit