Alumni Referral Program

Ursinus Alumni/Current Student Information

First Name

Last Name

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Preferred Shirt Size

Alumni Referral Type

Student Referral Type

Student's First Name

Student's Preferred Name (If different than first name)

Student's Last Name

Student's Birthdate (Not required, but this helps our system match records)

Student's Email Address

Student's Current High School

Student's Entry Term (Month and year they would be entering Ursinus)