Refer a Student

 Use this form to refer a prospective Shocker.

 

Do you know someone who should be a Shocker? Just complete the form below and we'll take care of the rest!

Please fill out the form below as completely and accurately as possible.

YOUR INFORMATION

I am a (check all that apply):
WSU Faculty Member
WSU Staff Member
WSU Alumnus/Alumna
Parent of the student being referred
High School Counselor/Teacher/Principal
 

First Name:

Last Name:

Phone:

e-mail Address:

STUDENT INFORMATION

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Phone:

Phone Type:             

Date of Birth:

e-mail Address:

Educational Status:              

Is the student currently attending school?                   Yes No

If yes, please enter the name of their school:

If no, please enter the name of the last school they attended:

High School Graduation Year:

GPA:

ACT:

Academic   

Interest(s):

Extracurricular

Interest(s):