Referral Form

Thank you for referring a student to Highlands College! Please be sure to contact us if you have any questions, please be sure to contact us at [email protected].

Student Information

First Name *

Last Name *

Email *

Phone Number *

Would you like to enter the student's address?

Street Address

City

State

Country

ZIP/Postal Code

Do you want to enter the student's church information?

Home Church Name

Home Church Pastor

Home Church City

Do you want to add the student's parent or guardian information?

Parent or Guardian Name

Parent or Guardian Email

Parent or Guardian Phone Number

What year would the student be enrolling into Highlands College? *

Your Information

Your Name *

Your Email *

Your Phone Number *

Your relationship to student *