ODUGlobal Advocacy and Care Team (ACT) Referral

This form is for ODU staff and faculty use to refer an ODUGlobal student.

Please fill out this form to refer an ODUGlobal student who may benefit from our ODUGlobal Advocacy and Care Team's (ACT) assistance. Your input is valuable in helping us provide the necessary support.

If there is documentation or additional information that would assist us, please attach to this form or email directly to GlobalAdvocacy@odu.edu.

Note: If you are reporting a concern related to ideas/thoughts of harm to self or others, please first immediately report the concern to the Threat Assessment team by submitting the Threat Assessment Referral Form . Second, submit this referral form, followed by a Teams message directly to a member of the ACT team (Cat Moss, Jacob Tousignaut, or Lisa Kivin).

Your Name (Referrer) *
Your ODU Email (Referrer) *
Student's Name Student's Name * First Last
Student's name on their university account
Student's Preferred Name

Student's preferred name (if known)
Student's UIN *
Must be 8 digits. Currently Entered: 0 digits.
Student's ODU Email *
Is the student aware that you are submitting a referral to our team? (Yes or No and briefly explain) *

Example: "Yes, I told the student during our advising meeting."
Reason for Referral *

Describe the reason for this referral and any specific concerns you have about the student.
Additional Comments

Optional: Provide any additional information that may be helpful for our team.
Documentation

Attach Files

Optional: Any support materials or documentation may be uploaded here or emailed directly to GlobalAdvocacy@odu.edu.