Academic Success Center - Mentoring Referral Form

Please use this form to refer a student who you believe would benefit from one-on-one peer mentoring regarding areas like study skills, time management, organizational strategies, etc.

Before making a referral, we strongly encourage that you communicate to the student that you are making this referral.

Student Name Student Name * First Last
Student UIN
Student Email
Student College/Major (if known)
Your Name Your Name * First Last
Your Email *
Your College/Department
What is the reason for the referral? *
I have communicated to the student that I am making this referral.

I have communicated to the student that I am making this referral. Yes No