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Alumni Referral Scholarship Application


* = required field
Rogers State University Logo Alumni Referral
Scholarship Application

Referring Alumni Information

First Name: * Last Name: * Maiden Name: *
If married at time of graduation.
If not applicable, please type NA.
Address: * City: * State: * ZIP: *
Phone: * Email: *
I attended: * Year Graduated: * Birthdate: *
I would like to receive more information regarding RSU Alumni Association: *
I would like to receive my free RSU Alumni Lifetime Membership: *

Enrolling Student Information

First Name: * Last Name: * Preferred Name: *
Address: * City: * State: * ZIP: *
Phone: * Email: *
Gender: * Student Applicant Type: *
Name of High School/College student last attended (leave blank if unknown):   
High School graduation year of student (leave blank if unknown):