NOTICE : Beginning Sept. 15, members of RIC Community must have valid parking permits. Click for details.

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