Ashland University Request for More Information

PALS Student Referral Form

(All fields with a * are required.)

Information on Student Being Referred:

* First Name: * Last Name:

Preferred Name: Gender: Female Male

* Address:

* City: * State:

* Zip: Ohio County:

* Email: * Phone:

High School:

City of high school:

* Year of Graduation:

* Term to begin AU (spring, summer, fall, year):

Your Information:

* First Name: * Last Name:

Address:

City: State:

Zip:

* Email: Phone:

* I am a:

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