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      SSC: Student Referral Form

      Fill out the following webform if you have a concern about a student regarding academic success, attendance, financial aid, etc. This information will go to the Director of the Student Success Center for response. Please put as much information as possible in the referral. 

      In cases where the student is a danger to her/himself or others, please contact the EKU Police Department immediately (phone: 859-622-1111). Please note that the SAIT form should be used to report students who appear to be troubled or troubling to elicit a response from University officials before the student's behavior reaches a crisis level.

      Information of Student to be Referred
      If you don't know the student's EKU ID number, please enter their EKU email address.
      Submitter Information
      Please describe your connection with the student:
      Please describe your connection with the student:
      Academic Challenges (select all that apply):
      Academic Challenges (select all that apply):
      Other Issues:
      Other Issues:
      Is the student at risk of leaving EKU?
      Is the student at risk of leaving EKU?
      • Eastern Kentucky University
      • 521 Lancaster Ave.
      • Whitlock Building
      • Richmond, KY 40475
      • Phone: 859-622-1000
      • eku.edu
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