Prospective Student Referral Form

Your Contact Information

Select all that apply

First Name

Last Name

Email Address

Are you currently an Alumni Ambassador at JCU?

Yes

No

Are you interested in becoming an Alumni Ambassador?

Yes

No

How do you know the student you are referring?

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Information about the Prospective Student

Student Type

Entry Term (typically the fall of the same year as the student's high school graduation year)

First Name

Last Name

Email Address

Permanent Address

Country

Street

City

Region

Postal Code

Current High School or College (begin typing the name and select the school from the list)

CEEB Code