(
*
indicates a required field.)
*
1).
Student's Name
*
2).
Student's Address:
3). Student Address 2:
*
4).
City
*
5).
State
*
6).
Zip
*
7).
Student's (and/or family) Phone Number
8). Student's Email Address
*
9).
Student's Year of High School Graduation
*
10).
Referring person's Name
*
11).
Referring person's Address
*
12).
City
*
13).
State
*
14).
Zip
*
15).
Referring person's Phone Number
*
16).
Referring person's Email Address
*
17). Additional information you would like to share about this student:
*
18). What is your relationship with ACU?
Alumnus
Trustee
Alumni Advisory Board
Friend of the University
ACU Faculty/Staff
Parent of Current/Former Student
Other
19). If you are filling out this form for someone else, what is your name?