PAC Student Referral Form
Hello! We are beginning to recruit for the upcoming 2021-2022 PAC Sessions beginning in October and we are looking for referrals! If you know any 9th-12th grade student at University Prep, Westinghouse, Sci-Tech, or Allderdice who may be interested or will benefit from joining the PAC Program, please use this form to refer them to our program. After you submit your referral, we will reach out to the student to send them more information on the program and have them complete an application. If you have any questions or concerns, feel free to contact us at PAC@pitt.edu.
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Your Full Name *
Your Email *
Your Phone Number *
Your Relation to the Student *
Full Student Name *
Student's Grade Level *
High School Student Attends *
Student Email
Student Phone Number
Student Address
If available, are you willing to facilitate an introduction or allow PAC representatives to present in your space?
Clear selection
Why do you think this student will benefit from joining the PAC Program? (200-400 Words)
Submit
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