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NDSU Faculty, Staff & Alumni
Prospective Student Referral Form

Name*

Student's First Name

Student's Last Name

Date of Birth (mm/dd/yyyy)

High School Information*

Student's Year of High School Graduation

High School/Last College Attended

Academic Interests

Student's Desired Major #1 (optional)

Student's Desired Major #2 (optional)

Contact Information*

Student's Address

Student's City

Student's State

Student's Zip

Student's Email Address

Referral Information*

Your Name

Your Email Address

Your affiliation to NDSU:*

Please leave any additional information that you would like us to know in the space provided below.