Potential Student Referral Form

Know someone who would make a great Builder?  Please use this form to refer a potential student for Southwestern!
 

Potential Student Information

First Name  
Last Name  
Address  
City  
State  
Zip  
Email Address  
Phone Number  
Name of Parent/Guardian  
High School  
H.S. Graduation Year  

Referral Information

Name of person making referral:  
Church or Organization:  

Reason for referral:

 

 

Southwestern College
100 College Street | Winfield, KS 67156-2499
1-800-846-1543
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