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