Student Success Referral Form

*NOTICE: If you have already received training on the new Student Success Hub referral process, please DO NOT use this form. If you still need training and access to the new referral system, contact Emily Myers at emyers@ehc.edu.*

Thank you for reaching out to The Office of Student Success! Our staff is ready to work alongside students in a variety of capacities to ensure their success, both in and out of the classroom. Please take a few moments to answer the questions below so we can provide the best possible support. Thank you!

*If this is an emergency, please call Campus Safety (x6222) or 911 right away!

All fields marked with asterisk (*) are required.

required text field

Referrer's Name*

required e-mail address field

Referrer's Email*

required text field

Student's Name*

text field

Student's Email

required select menu field

Is the student an athlete?*

required select menu field

Please indicate the general nature of your concern.*

(You may select more than one option by pressing the "CTRL" key.)

required textarea field

Please take a moment to share a couple of sentences describing your concern in more detail.*

file attachment field

If you have additional documents that would help the Student Success Team better understand the nature of your concern, please attach those here.

(50 MB max)

Link (required)