Loyola University Chicago


Student Referral Form

Thank you for your making a referral on behalf of a student. The purpose of this form is to allow faculty and staff to refer students who need extra care and assistance. Our intention is to be a centralized resource to make sure students have access to and information about the services available at Loyola. Students who are referred will be contacted by a member of the Hub staff to further assess their needs. Appropriate follow-up measures will be taken as necessary.

In the event we need to follow-up with you, this report must contain your name, phone number and email address. For this to be a collaborative process, the students must be aware that the referral is being made. Therefore, this is not an anonymous or confidential report.

Please note that this form is NOT for reporting student conduct issues or student behavioral concerns. Please refer to the Office of Student Conduct and Conflict Resolution website to complete an incident report: LUC.edu/osccr/studentconduct/incidentreport/. For behavior concerns, please report these to the Behavioral Concerns Team (BCT): LUC.edu/bct/forms/referral/.

If you have questions, please contact Terri Thomas, Director, Student Academic Services, at tthom1@luc.edu.

*indicates required fields
Reporter's Name:
*Reporter's Role: Faculty
*Reporter's Department:
*Reporter's Phone:
*Reporter's E-mail:
*Please Re-enter Reporter's E-mail:
*Student ID:
*Student's First Name:
*Student's Last Name:
*Student's Phone:
*Student's E-mail:
*Issue/Concern: Academic