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Support Salem: Refer a Prospective Student for Admission
Use the form below to refer a student to Salem. Referred students will receive a letter telling them that a Salem Alum referred them to the admissions office. Your name will not appear on the letter if you choose the privacy option below. Asterisks (*) denote required field.

* Prospect's First Name:
* Prospect's Last Name:
* Prospect's Address:
* Prospect's City:
* Prospect's State:
Prospect's Zip:
Prospect's Country: (if other than USA)
Prospect's Home Phone:
Prospect's E-Mail:
Prospect's High School:
Prospect's Graduation Year:
Prospect's Intended Major:
Your Name:
Your Email Address:
Please provide any comments that you would like to make about this student:
Do you wish to make this referral annonymously?	Yes No

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