Academic Enhancement  


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Early Intervention - Faculty Referral Form


The Early Intervention is a referral source to help faculty members and others who are concerned about student’s progress throughout the semester, especially during the crucial weeks (4-6 weeks) prior to midterms.  To learn more, click here.

When you complete and send this form, the Office of Academic Enhancement will contact the identified student. An appointment will be made to assess the student's needs and to design a personalized plan to address the reported concern.


Today's Date


Name of Student                            


Student UIN


Student Contact Information (if known)




Referring Faculty


Contact Information for Referring Faculty


Reason for referral (check all that apply)

   Frequent or unexcused absences

   Tardiness/late to class

   Low quiz/test scores

   Poor quality assignments/homework

   Study skills

   Lack of preparedness

   Classroom behavior/attitude



Did you contact this student before completing this referral?

Yes     No


If yes, how did you contact the student?


If you chose "Other", please explain:


Additional Comments




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