Refer a Student

Thank you for referring a student. If you have problems submitting this form, please email EmmanuelNews@ec.edu.

To refer multiple prospects, please submit separate online forms.

Did prospect's parents attend Emmanuel?: *

yes

not sure

If parents attended, the student qualifies for a Legacy Scholarship.

Full Name of Prospective Student: *

Prospect's Home Phone Number: *

Prospect's Cell Phone Number:

Prospect's E-Mail Address: *

Street Address: *

City: *

State: *

Zip Code: *

Prospect's Gender: *

Male

Female

Prospect's Date of Birth:

Name of Prospect's High School:

Prospect's High School Graduation Year:

Name of Prospect's Church:

If IPHC, which conference?:

Special interests, skill, talents of prospect:

May we tell the prospective student that you referred him/her to us?: *

Yes

Your Relationship to Prospect:

How long have you known the prospect?:

Additional Comments About Prospect:

Your Name:

Prospect's approximate age:

Alumni & Friends