Student Advocate Intake Form

Student Advocate Intake Form
Date of Initial Contact:*

MonthDayYear
Type of Contact:*

In-OfficePhoneE-mailMail
Student Full Name*

First NameMiddle NameLast Name
Student A# *
Your Name (if not student):

First NameLast Name
Relationship to Student:
Status: *

FreshmanSophomoreAlumni/Former Student
Type of Student: *

CurrentRe-AdmitFirst-TimeProspectiveDual EnrollmentNon-CreditOther
Primary Campus: *

DecaturHuntsvilleBothAlabama 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):*

AdmissionsAdvisingFinancial AidInstructionalGraduationDisciplinaryStudent ActivitiesPersonal/GeneralBusiness OfficeDisability/ADAStudent ServicesOther
Please elaborate on these issues:
Admissions Issues:

Admission/Application ProcessRegistrationTranscript IssueDrop/Add IssueBankruptcy/Course ForgivenessProbation/SuspensionCustomer ServiceWithdrawal (Medical, other)FERPATransient Student IssueOther
Advising Issues:

AdvisingOrientationCareer Services/Job PlacementPlacement TestMAPS PlanRecruitmentCampus TourCustomer ServiceOther
Financial Aid Issues:

Pell Grant/FAFSAStudent LoanScholarshipApplication/PaperworkFinancial Aid AppealVeteran IssueCustomer ServiceOther
Instructional Issues:

Faculty ComplaintProgram ComplaintGrade AppealCourse OfferingsReinstatementClass/Medical WithdrawalIncompleteOnline/IT IssueContact InstructorOther
Graduation Issues:

RequirementsCosts/FeesCeremony Issues/QuestionsDeadlinesRegalia QuestionsOther
Disciplinary Issues:

Faculty DisputeGrade DisputePlagiarismDiscipline Hearing/Follow-upGrievance ProcessCheatingCode of Student ConductSexual HarassmentBullyingOther
Student Activities Issues:

Club/Organization InformationEvent Information/DatesApplication Process for Clubs/OrganizationsOther
Personal/General Issues:

TransportationChildcareHousingDirections to ClassPhysical/Emotional ProblemsCounseling RequestInsurance InquiryOther
Business Office Issues:

Tuition PaymentParking DecalRefundPayment PlanCustomer ServiceOther
Disability/ADA Issues:

AccommodationsPaperwork/ApplicationBook Loan ProgramCustomer ServiceOther
Student Services Issues:

TutoringService LearningHonors DayStudent IDCustomer ServiceOther
Other (Please explain)
Should be Empty:

Student Advocate Intake Form

Please elaborate on these issues: