Student REFERRAL Form

WILEY COLLEGE

711 Wiley Ave, Marshall, TX, 75670

admissions@wileyc.edu

(903) 927-3300
FUTURE WILDCAT REFERRAL Form

Student Information
Student's Full Name

First NameMiddle NameLast Name
Student's Mobile Phone
Student's Email
Student's Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How do you know the student?
ex. Father, Mother, etc.

Academic Background
High School Name
High School Graduation Year
High School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Academic Interests
Other Interests (Band, Debate, Acapella Choir, Athletics, etc)
Student's Social Media Accounts (Instagram, Tik Tok, Twitter, etc)
Suggestions / Comments

Your Information
Your Name

First NameLast Name
Your Phone Number
Your Email
Are you a part of an alumni club?

YesNo
If yes, list the alumni club.

Parent's Information
Parent's Name

First NameLast Name
Parent's Email
example@example.com
Parent's Phone Number
Please enter a valid phone number.
Should be Empty: