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

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