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Are you Faculty,Staff, Connection Leader, or Resident Assistant?

What year is this student?

Does this student live on or off campus?

Please select an area of concern: (If the area of concern pertains to attendance or academic performance please provide the course# that the student is being referred for).  

Have you had a one-on-one conversation with this student pertaining to the concern?

Mode of Communication that you've had with the student:

What is the best way to contact this student?

Have you referred this student to any other office or individual on campus?

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