Youth Minister Referral Form

As a youth minister, you are aware of the students who desire to pursue academic excellence in an environment that strengthens the Christian walk. Please refer those students to us by completing the form below with the students information so we may 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
Name of High School Student Attends:*
Name of Church Student Attends:*
Name of Person Completing This Form:*
Contact Phone of Person Completing This Form:*
All fields marked with an asterisk (*) are mandatory.