Prospective Student Referral to Admissions

Please use this form to make an undergraduate prospective student referral to the Office of Admissions.

Please provide as much information as you can about the student. The more information we have, the better we can recruit the student. Please note that if you are unable to provide at least one method of contacting this student, recruitment communication from the Office of Admissions will be delayed until that information can be obtained.

Prospective Student Data

First Name*

Middle Name

Last Name*

Preferred First Name*

Birthdate*

Prospective Student Contact Information

Email Address*

Mailing Address (Please provide as much information as you can, even if it is only city and state.)*

Prospective Student Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone*

Prospective Student Referral Information

What is your affiliation with Southern Miss?
(CTRL+Click to select multiple)

Any other information that would assist in this student's recruitment?

Examples are: academic interest, honors/awards, other universities or colleges being considered, personality traits, etc.

Is this prospective student the child or grandchild of a Southern Miss alumni?

Is this prospective student the child of a Southern Miss faculty/staff member? ONLY select box if YES.

Prospective Student Recruitment Details

Anticipated High School Graduation Year

Anticipated Start Term

Anticipated Type of Student

Most Recently Attended School

Referral Information

Your First Name*

Your Last Name*