Berea College - Prospective Students - Nominate a Student Form

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Berea College
Office of Admissions
CPO 2220
Berea, KY 40404

Phone: 859-985-3500
Toll-Free: 800-326-5948
Fax: 859-985-3512

Haaga House
Office Hours:
M–F, 8:00 a.m.–5:00 p.m.
Sat, By Appointment
Sun, Closed

Nominate a Student Form

Nominee

Name of Junior or Senior:

*

Gender:

Male

Female

Address:

*

Address:

City:

*

State:

*

Zip:

*

Phone:

Year of High School Graduation:

*

High School:

Special Achievements, Honors or Comments:

Nominated By

Prefix:

Mr.

Ms.

Other

Name:

*

Title:

Name of company, organization, or school:

Address:

*

Address:

City:

*

State:

*

Zip:

*

Are you a Berea alum?

Yes No

	Please check here if you DO NOT wish for us to disclose your name to the student being nominated.