Refer a Student

Thank you for your willingness to continue the legacy from NYCC to Northeast College of Health Sciences. Please share with us the following information about yourself. You will enter the information about who you are referring when you continue to the next page.

Your Information:

Salutation*

Dr.

Mr.

Mrs.

Ms.

First Name*

Last Name*

Email Address*

Primary Phone No.*

Mailing Address*

Country

Street

City

Region

Postal Code

What is your relationship to Northeast College or NYCC?*

Alum

Friend of the College