Prospective Panther Referral Form

FIU is looking for new students who want to go beyond what is expected and do something great with the opportunities they’ve been given; students who are driven and whose academic record point to success. We’re looking for students who not only want to make a difference, but are already participating in activities that have a significant impact on our community.

Do you know someone who is ready to be Worlds Ahead at FIU?

Please fill out the following form to help us get in touch with students you know.

The Prospective Panther Referral program is an exclusive benefit of FIU alumni.

Your Name Your Name First Last
Your Phone Your Phone - ### - ### ####
Your Email
Your Relationship to the Student
Are you an FIU alumnus/alumna?

Are you an FIU alumnus/alumna? Yes No
Please select one of the following
Panther ID
Birthdate Birthdate / MM / DD YYYY
Student Information
Name Name First Last
Phone Phone - ### - ### ####
Email
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Birth date Birth date / MM / DD YYYY
Graduation Year
College/High School
Preferred Major
Parent Information
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Email

Prospective Panther Referral Form

Prospective Panther Referral Form

Student Information

Parent Information