Northern State University

Student Referral and Support Program

STUDENT'S NAME:                 

REFERRED BY (your name): 

        Please check here if you have spoken with the student about this referral.

REFERRED TO:

University College                                       Counseling Center, SC 217; x2371                            

        Math Center, DH 209; x 7782                        Test Anxiety, SC 217; x 2371            

        PASS Program, DH 201; x 2633                    Time Management, SC 217; x 2371            

        Exam Review, DH 201; x 2633                          Stress Management, SC 217; x 2371             

        Study Skills, DH 201; x 2633                         Retention Ass't, SC 217; x 2371                              

        Tutoring, DH 201; x 2633                             Personal Issues, SC 217; x 2371                        

        Writing Center, DH 209; x 7782                Health Services, SC 229; x 7694

         Reading Center, DH 201; x 3427           

Enrollment Services, DH 101; x 3400          Residence Life, SC 201; x 3007

Hall Director for hall            Multicultural Office, SC 207; x 3007

Veteran's Affairs, DH 111; x 7692              Disability Services, SC 217; x 2371

Career Development & Placement, SC 217; x 2371                      

SD Career Center (formerly Job Service), SC 234; x 7689

Reason for Referral:

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This area to be completed by SRSP office:

ID #:                 Telephone #:

Advisor:         Campus Address: