Student Success Academic Referral Form
Use this form to alert support counselors of a student who has demonstrated academic or non-academic behaviors that may result in poor academic performance in your course and may benefit from addional intervention. Support counselors will reach out and offer assistance/resources as deemed appropriate to guide student on the path to success.
Would this student benefit from a Behavioral Intervention Team (BIT) referral instead of an Academic Referral? (Examples of BIT referrals include substance abuse, homelessness, mental health, victims of abuse, financial issues and significant behavior issues) BIT referals should not be completed with this form, but should be sent via an informtaional email to email@example.com.