RMU Referral Program

ADMIN ONLY: This referral has been contacted.
ADMIN ONLY: A gift has been sent
Your Information

The person referring a prospective student.
Your Name

First NameLast Name
Your Email
example@example.com
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Relationship to Rocky Mountain University of Health Professions

Other
What program were you associated with at RMU?
If you're an employee, please mark N/A.
What semester and year did you begin your program (applicable to current students and alumni)(Mark N/A for faculty/employee?)
What department at RMU do you work for?
Do you wish to waive/decline your thank-you gift?
Have you referred someone in the last 12 months?
T-Shirt Size
Prospective Student Information
How should this prospective student be contacted?
Prospective Student Name

First NameLast Name
Prospective Student Email
example@example.com
Prospective Student Phone
Please enter a valid phone number.Format: (000) 000-0000.
* indicates required fields
Prospective Student Department of Interest
Prospective Student Counseling Program of Interest
Prospective Student Health Sciences Program of Interest
Prospective Student Nursing Program of Interest
Prospective Student Occupational Therapy Program of Interest
Prospective Student Physical Therapy Program of Interest
Prospective Student Physician Assistant Program of Interest
Prospective Student Speech-Language Pathology Program of Interest
Prospective Student Phone
Please enter a valid phone number.Format: (000) 000-0000.
Prospective Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your relationship to this prospective student?
Prospective Student Primary Program of Interest
Why is this person a good fit for Rocky Mountain University?
I acknowledge I have read and understood the terms and conditions.
Click the "Submit" button to update the referral contact status or the gift status.
Should be Empty:

Your Information

Prospective Student Information