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Early Intervention Form

The Office of Student Life is asking you to help identify students about whom you have a concern. When problems persist in spite of your involvement, you are encouraged to either call the office at (401) 456-8061 or stop by Craig Lee 119 and speak with the Dean of Students or his/her designee. Alternatively, you may complete the referral form below; however if this is an emergency, you should notify the appropriate campus authority (Dean of Students, Counseling Center, Health Services, Campus Police) immediately.

Note: This referral is not for disciplinary purposes, but rather to help a student who is experiencing a problem that may affect his/her academic success.

Please don't use this field.
Your Name
Your Telephone
Your Email
Relationship to Student

Student Information

Student's Name
Student's Email
Student's Campus Address
(if known)
Student's Off-Campus Address
(if known)

I am concerned because this student has (check all that apply):

Suddenly stopped going to class without explanation
Performed uncharacteristically below expectations on quizzes, exams and/or homework
Had other academic problems
(processing information, grasping concepts, possible learning disability)
Not been seen in a number of days
Talked about leaving RIC
Had significant behavioral or mood/attitude/appearance changes
Acted or made statements of general concern
Presented a risk of harm to self or others
Mentioned family/personal problems
Please provide information regarding the specific behavior(s) of concern:
 
Click here for Campus Resource List
 
This information is sent directly to the Office of Student Life. After you make a referral, we will acknowledge receipt of your submission. We also may contact you for further discussion or follow up regarding the student.

Page last updated: May 16, 2013