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Referal Form
Referal

Before completing this referral, please consider the following:

  • Given the background knowledge you have about this student, what is the best course of action for him/her.
  • Many students referred to CRP are "at risk." Please consider whether or not CRP is the appropriate place for the student and if he/she has the capability to be academically successful at this time.
  • Alternatives that may better serve the student, if they've experienced difficulty coping with serious health, personal or other issues that may be beyond the scope of what this program is able to offer.
In order to schedule students as soon as possible, complete this form and instruct the student to go to the CRP web site to complete an online application

Once we receive both the department's referral and the student's application/questionnaire, we will check the student's eligibility, which includes no "I" grades, and no financial and disciplinary holds. if a spot is available, the student's will be placed on the "ACTIVE" list, and they will be notified of their acceptance. We will accept up to 55 eligible students per term on a first-come first-served basis. For questions, please contact:

Director
Dawn Herman
585-475-2982

or

Administrative Assistant
Jackie Perez
585-475-5536

Student's Information:

* denotes a required field

Student's Name:*

College:*

Major:*

Term:*

Background Information

Student is facing: * (check one)

*Please provide any insight you may have about the factors that contributed to this student's academic difficulty, i.e., reading/writing/math skill level, personal issues, developmental problems, career issues, financial problems, etc.

EXIT OPTIONS

(Please check all that may apply)




Reinstatement Conditions

Student must achieve a minimum of the following conditions in order to be considered for reinstatement/internal transfer. (check all that apply)

Min. GPA for CRP classes Min. GPA for credit classes Lowest Grade












RECOMMENDED CREDIT COURSES

Please enroll the student you are referring to CRP in to 2 RIT credit courses that would act as good indicators of success for reinstatement. Please list these courses below:


Primary Recommended Courses Course 1*.   Course 2*.  

Please list additional recommended courses below, especially if the student may not return to the referring department. Courses that the student previously received a D, F, or W in would be good repeat courses.

Secondary Recommended Courses Course 3.   Course 4.  


Name of referring person:*  
Office address:*      Phone:*      RIT E-mail:*   (Ex: slsa@rit.edu)