Student Advocate Intake Form
Type of Contact
*
In-Office
Phone
Email
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
Other
Primary Campus
*
Decatur
Huntsville
Both
Alabama Center for the Arts (ACA)
Online
Primary Phone
*
-
Area Code
Phone Number
Primary Email
*
example@example.com
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
Other
Please elaborate on these issues:
Other (Please explain)
Submit
Should be Empty: