Beloit College/WESLI Pathway to Excellence Student Nomination Form

Thank you for nominating a student for enrollment in this program. This form is intended for the use of recruiters with a partnership with Beloit College/WESLI.

Please provide as much information as you are able. After you submit this form, the student will be emailed login information to complete the application for admission.

Prospective Student Information

*Indicates a required field

Student's Email Address*

First/Given Name*

Middle Name

Last/Family Name*

Student's Birthdate*

Student's Anticipated Year of Secondary School Completion*

Nominator's Information

Name*

Email Address*

Recruiting Partner Agency*