Refer a Student

Use this form when a student would benefit from a meeting with a success coordinator. Include their ID and as much detail as you can. You can also use it just to put someone on our radar.

Required fields are marked with *

When to use this form (SSI vs school referral)

This form replaces the SSI for academic-only issues. If the student is at risk of failing the course, submit both an SSI and a school referral. If there is an academic concern and other issues, submit the SSI for those other issues and note that you have also submitted a school success referral for academics. Complete an SSI only when there is a major concern about the student’s ability to persist.

Examples: they are not using suggested support services; a suspected disability with no letter of accommodations; risk of failing (SSI plus school referral); housing or food insecurity; death or hospitalization of an immediate family member. Do not submit an SSI for each failing exam — those go to a school referral.

This form does not replace meeting with the student as course faculty or an academic advisor. If you are referring a student in your course, meet with them first and tell us what you already covered. If you said you would meet soon, update the Success Team after that meeting.

Student information

Student ID * This can be found in the "PEOPLE" section of your Canvas course.

First name *

Last name *

Email *

Courses Include the course number, for example NG545.

Program *

Concern and referral

This form does not take the place of an SSI. If an SSI is needed, submit a separate university form.

Has faculty already completed an SSI? *

YesPlanning toNo Yes: SSI already submitted (major persist concerns, failing at midterm, or non-academic issues). Planning to: you will submit an SSI. No: academic-only — this form is enough.

Issues / concerns *

Action required

Student will scheduleCoordinator should reach outStudent is required to meetInforming only If the student's score is below 68, or they need an 85+ average on remaining exams, they are required to meet with the team.

Other action for student Required if you do not select an action above.

Referring faculty

First name *

Last name *

Email *

Relationship to student

AdvisorCourse FacultySuccess CoordinatorCAS

Other Required if you do not select a relationship above.