This form is to be used by instructors to alert advisors of potential concerns with students. Student Success will use the information provided to facilitate communication between the student and instructor.
Disclaimer: If you have an immediate concern about the student's safety, please contact the USM Police Department at 780-5211.
As a result of submitting this form:
- Students will be contacted by the Student Success Center. The student's academic advisor will receive documentation of that contact.
- Anything submitted will be documented and put in the Advising file.
- You may wish to print this form prior to submission to retain a copy for yourself.
By submitting this form, you may be contacted for more information.
To contact Academic Assessment about the use of this form, please email Kristen Beahm, firstname.lastname@example.org or call 228-8086.