Learning Assistance Referrals

If a student falls within the target population and receives an early alert, withdraws from a course, or is experiencing academic barriers, they may be referred to the AIM Program’s Learning Assistant. This will enable the student to access support early on in their transition. These referrals may happen at any point during the academic year.

To make a referral to the Learning Assistant please fill out the form below. After submitting the form, please print two copies of the referral, one for your records and one for the student. Please inform the student that they will be contacted by the Learning Assistant to schedule an intake meeting.

Referrer's Name*	A value is required.
Referrer's Title*	A value is required.
Referrer's Department*	A value is required.
Referrer's Email*	A value is required.
Referrer's Phone Number*	A value is required.
Student's Name*	A value is required.
Student's Major*	A value is required.
Student's Email*	A value is required.
Student's Phone Number
Reason For Referral*
A value is required.
* denotes a mandatory field