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?
						
							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