Student Advocate Intake Form

Student Advocate Intake Form
Date of Initial Contact:*

MonthDayYear
In-OfficePhoneE-mailMail
Student Full Name*

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

First NameLast Name
Relationship to Student:
FreshmanSophomoreAlumni/Former Student
CurrentRe-AdmitFirst-TimeProspectiveDual EnrollmentNon-CreditOther
DecaturHuntsvilleBothAlabama Center for the Arts (ACA)Online
Primary Phone:*
Format: (000) 000-0000.
Primary E-mail:*
AdmissionsAdvisingFinancial AidInstructionalGraduationDisciplinaryStudent ActivitiesPersonal/GeneralBusiness OfficeDisability/ADAStudent ServicesOther
Please elaborate on these issues:
Admission/Application ProcessRegistrationTranscript IssueDrop/Add IssueBankruptcy/Course ForgivenessProbation/SuspensionCustomer ServiceWithdrawal (Medical, other)FERPATransient Student IssueOther
AdvisingOrientationCareer Services/Job PlacementPlacement TestMAPS PlanRecruitmentCampus TourCustomer ServiceOther
Pell Grant/FAFSAStudent LoanScholarshipApplication/PaperworkFinancial Aid AppealVeteran IssueCustomer ServiceOther
Faculty ComplaintProgram ComplaintGrade AppealCourse OfferingsReinstatementClass/Medical WithdrawalIncompleteOnline/IT IssueContact InstructorOther
RequirementsCosts/FeesCeremony Issues/QuestionsDeadlinesRegalia QuestionsOther
Faculty DisputeGrade DisputePlagiarismDiscipline Hearing/Follow-upGrievance ProcessCheatingCode of Student ConductSexual HarassmentBullyingOther
Club/Organization InformationEvent Information/DatesApplication Process for Clubs/OrganizationsOther
TransportationChildcareHousingDirections to ClassPhysical/Emotional ProblemsCounseling RequestInsurance InquiryOther
Tuition PaymentParking DecalRefundPayment PlanCustomer ServiceOther
AccommodationsPaperwork/ApplicationBook Loan ProgramCustomer ServiceOther
TutoringService LearningHonors DayStudent IDCustomer ServiceOther
Other (Please explain)
Should be Empty:

Student Advocate Intake Form

Please elaborate on these issues: