Mustang Referral Form

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Mustang Referral Form

Concerned about a current SMSU student? The following referral form is to be used by SMSU service faculty/staff and students. Teaching faculty may utilize this form outside of designated reporting time frames (week 3 and week 7 of each semester); however, ask that they follow early alert procedures through Hobson's Retain when the survey is made available to them. For more information, please click on the following link: http://www.smsu.edu/campuslife/studentsuccess/?id=7459 

Please fill out the form to the best of your ability. Note: In order to help the student with his/her needs, the student will be informed of who referred them.

Referral Form
University Classification of
Student (if known):




I am concerned with this
student because of the following
reason(s) - check all that apply: *









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Southwest Minnesota State University

1501 State St. Marshall, MN 56258
1-800-642-0684
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We are an affirmative action / equal opportunity university.
Southwest Minnesota State University is a member of the Minnesota State system.