Academic Counseling Referral Form
PLEASE BE ADVISED: This form is NOT intended to address classroom management concerns (i.e. attendance, sleeping in class, missing books, missed assignments, failing exams, etc.).
This form should be completed after an in-person conversation with the student has taken place. If you determine that there are underlying issues affecting him/her, please bring them to the attention of an Academic Counselor by completing this form. Those issues could potentially affect the student’s academic success in your class.