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 Campus Management Retain when the survey is made available to them. For more information, please click on the following link: http://www.smsu.edu/campuslife/ssac/early-alert-procedures.html

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.