Need Assistance?

Enter your information below and a personal assistant from Chancellors will contact you right back.

Chancellor's Referral Form

If you have a friend or colleague interested in earning a nursing degree with help from Chancellor's, please fill out this form. When we receive completed paperwork from your friend for five or more study guides, we will send you a $100 Referral Bonus. Please allow 60 days for processing. (Also, please keep in mind that Certified Nursing Assistants are generally not eligible for the program.)

All form fields are required for the referral to be processed.

Your Information:

Your Name:
Your E-mail:
Your Phone :

Referral's Information:

Referral's Name:
Referral's E-mail:
Referral's Address:
Referral's Zip:
Referral's :
Referral's License Status:
To prevent abuse of this form, please enter the letters you see in the image below: