Student Advocate Intake Form

Student Advocate Intake Form
Date of Initial Contact: *

Month Day Year
Type of Contact: *

In-Office Phone E-mail Mail
Student Full Name *

First Name Middle Name Last Name
Student A# *
Your Name (if not student):

First Name Last Name
Relationship to Student:
Status: *

Freshman Sophomore Alumni/Former Student
Type of Student: *

Current Re-Admit First-Time Prospective Dual Enrollment Non-Credit
Primary Campus: *

Decatur Huntsville Both Alabama Center for the Arts (ACA) Online
Primary Phone: *
Primary E-mail: *
Please tell us your reason for contacting the Student Advocate Office (check all that apply): *

Admissions Advising Financial Aid Instructional Graduation Disciplinary Student Activities Personal/General Business Office Disability/ADA Student Services
Please elaborate on these issues:
Admissions Issues:

Admission/Application Process Registration Transcript Issue Drop/Add Issue Bankruptcy/Course Forgiveness Probation/Suspension Customer Service Withdrawal (Medical, other) FERPA Transient Student Issue
Advising Issues:

Advising Orientation Career Services/Job Placement Placement Test MAPS Plan Recruitment Campus Tour Customer Service
Financial Aid Issues:

Pell Grant/FAFSA Student Loan Scholarship Application/Paperwork Financial Aid Appeal Veteran Issue Customer Service
Instructional Issues:

Faculty Complaint Program Complaint Grade Appeal Course Offerings Reinstatement Class/Medical Withdrawal Incomplete Online/IT Issue Contact Instructor
Graduation Issues:

Requirements Costs/Fees Ceremony Issues/Questions Deadlines Regalia Questions
Disciplinary Issues:

Faculty Dispute Grade Dispute Plagiarism Discipline Hearing/Follow-up Grievance Process Cheating Code of Student Conduct Sexual Harassment Bullying
Student Activities Issues:

Club/Organization Information Event Information/Dates Application Process for Clubs/Organizations
Personal/General Issues:

Transportation Childcare Housing Directions to Class Physical/Emotional Problems Counseling Request Insurance Inquiry
Business Office Issues:

Tuition Payment Parking Decal Refund Payment Plan Customer Service
Disability/ADA Issues:

Accommodations Paperwork/Application Book Loan Program Customer Service
Student Services Issues:

Tutoring Service Learning Honors Day Student ID Customer Service
Other (Please explain)
Should be Empty:

Student Advocate Intake Form

Please elaborate on these issues: