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Parker University

Refer a Student Form

To make a referral, please complete the form below. We will follow up with the student you refer within five business days. Before you make the referral, please consider:

  • Letting the person know you are planning to refer them. This makes our conversations with them go more smoothly.
  • Identifying their preferred method of communication, such as e-mail or mobile phone, and including that on the form.
  • The academic background of the student. Are they a young adult currently in college? Are they currently in a different career? This information helps us know the right approach for our follow up.

About the Prospective Student

 

Fields in bold with an * are required:

First Name: *
Last Name: *
Address: *
Address 2:
City: *
State/Province: *
Zip/Postal: *
 example: 75229 or NE11-0JA
Country:
E-Mail: *
Phone: *
Preferred contact method: *
                                                               

Please check all that apply for this prospective student:




                                                               

How committed is this prospective student to becoming a chiropractor?   1 being not at all and 5 being completely committed.
How committed is this prospective student to attending Parker University?   1 being not at all and 5 being completely committed

About You the Referrer

 
First Name: *
Last Name: *
E-Mail: *
Grad Year (if Parker alum):
 

   
   
If you experience problems with this form, please contact askparkeradmissions@parker.edu.