Counselor Referral Form

As a counselor, you are aware of students that desire the educational experience ETBU provides. Please complete the form below with the students information so we can contact them about the opportunities available at East Texas Baptist University.

Student First Name:*
Student Last Name:*
Student Mailing Address:
City:
State:
Zip:
Student Email Address:
Student Preferred Phone:
High School Classification:	Freshman Sophomore Junior Senior HS Graduate
Community College Classification:	None Dual Enrollment Only Freshman Sophomore
Name of High School Student Attends:
Name of Community College Student Attends:
Name of Person Completing This Form:*
Phone of Person Completing This Form:*
All fields marked with an asterisk (*) are mandatory.