Millsaps College Student Referral Form

The aim of this program is to increase applications from well-qualified students. Even if the student has already been admitted, we ask that you still complete this form. The strength of your referral may carry additional weight when applicants are considered for admission and scholarships to Millsaps College, however no pre-determined scholarship amount will be automatically awarded.

Prospective Student Information:

* = Required Fields. Please submit a separate form for each referral you would like to submit.

*Student's First Name

Student's Preferred Name

*Student's Last Name

Student's Gender

Female

Male

Student's Birthdate

Student's Mobile Phone

Student's Email

Student's Mailing Address

Country

Street

City

Region

Postal Code

Current (or most recent) high school, or college attended

High School Graduation Year

Parent Information:

Parent's First Name

Parent's Last Name

Parent's Email Address

Parent's Mobile Phone

*Did the parent attend Millsaps?

**Please enter either the student email or their parent's email address to continue**

Your Information:

* = Required Fields. Please submit a separate form for each referral you would like to submit.

*Referrer's First Name:

*Referrer's Last Name:

Referrer's Phone Number

*Referrer's Email Address

*Referrer's Relation to Millsaps

*How do you know the student (please select one)?

If you are a Millsaps Alum, please list your class year and last name if different from above:

Please write a recommendation for the student explaining why they would be a good fit for Millsaps College (this field is NOT required but may strengthen a student's candidacy for admission and scholarships)

Thank you for taking the time to complete this form. Upon successful submission of this form, you will receive a confirmation message.