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I am concerned about a student:


Your Name:

Student's Name:

Area of Concern:
Academic  Personal  Financial  Residence Hall 
Not Attending Class  Social Withdrawal  Other 

Issue of Concern:
Have you talked to the student about this issue? Yes  No 
May we contact the student? Yes  No 
Would you like a follow-up call or e-mail? Yes  No 

If you feel this issue should be referred to the Crisis Team, please contact Dr. John Adams at jadams@shepherd.edu or ext. 5122.


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Shepherd University | Office of Admissions | P.O. Box 3210 | Shepherdstown, WV | 25443-3210 | 304-876-5212 | 800-344-5231 | FAX 304-876-5165 | E-Mail: admissions@shepherd.edu