RUSH REFERRAL FORM

Thanks for your interest in connecting a promising Deke with a great chapter!
The information will be forwarded immediately to the appropriate chapter(s) and recruitment chair(s).

Candidate Info

First Name
Last Name
High School / Preparatory School
College/University he will be attending
Home Address
Address Cont.
City
State / Province
Postal Code
Home Phone
Home E-mail
Campus Address
Address Cont.
City
State / Province
Postal Code
Campus Phone
E-mail

Referrer Information
(from the person making this recommendation)
First Name
Last Name
Chapter
Graduation Year
Street Address
Address Cont.
City
State / Province
Postal Code
Phone
E-mail
Additional information from the reference, or about the candidate
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