Office of Admissions

Nominate a Student Form

Nominee

Name of
High School 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.
 Yes No    
   

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