Referral Form for NMU’s Academic Support & Student Intervention Services Team

Thank you for considering a student for the ASSIST program. We greatly appreciate your time in completing this referral! Our goal is to help students who need an extra support system work on the skills necessary to succeed!

Please complete the form below and provide us with the details of your student referral.

All information shared will remain confidential. We will not tell the student who referred them; the referrer retains the right to disclose if they so choose.

Student Referral Form for NMU’s ASSIST Program

Student Information

Student's First Name

Student's Last Name

Student's NMU IN (if known)

NMU INs have 8 digits and may start with one or more zeros.

Student's Email Address (if known)

Is this student First-Generation?

Yes

Not sure

Tell us a bit about why you think this student could benefit from our services?

Referrer Information

Referrer's Name

Referrer's Relation to the Student

Referrer's Email Address