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Student
Referral 1:
(please provide as much
information as possible, we recognize
some information may not be available) |
*First Name:
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Date of Birth:
(mm/dd/yyyy) |
*Last Name:
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Phone:
E.G. (999) 888-7777 |
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Email
Address:
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Street Address:
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P.O. Box:
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City:
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Province/State:
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Postal Code/Zip:
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Country:
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High School Name:
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What grade is the student currently
enrolled:
High School Grade:
9
10
11
12
Attending
another university/college
OR
Not
currently attending an educational institution |
| Expected
Year to Start University:
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Interests (i.e. plays hockey, wants to
study business, etc.)
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Student
Referral 2:
(please provide as much
information as possible, we recognize
some information may not be available) |
*First Name:
|
Date of Birth:
(mm/dd/yyyy) |
*Last Name:
|
Phone:
E.G. (999) 888-7777 |
|
Email
Address:
|
Street Address:
|
P.O. Box:
|
City:
|
Province/State:
|
Postal Code/Zip:
|
Country:
|
High School Name:
|
What grade is the student currently
enrolled:
High School Grade:
9
10
11
12
Attending
another university/college
OR
Not
currently attending an educational institution |
| Expected
Year to Start University:
|
|
Interests (i.e. plays hockey, wants to
study business, etc.)
|
|
|
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Consent:
*By submission of this
form, I hereby provide my consent that Acadia University may
provide
the student(s) referred above with my name as the person who has referred them to this program.
I have communicated
to the student(s) referred above that I am providing
their contact information for Acadia University to
contact them. |
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Check out our prospective student web portal. |