Home | Address Book | Search | Sitemap | Contact Us

SuccessNet

Referral

Thank you for your concern and willingness to make a referral to the SuccessNet team for intervention purposes. In an effort to assist individuals in working through any problematic issue that may be impeding their success, we will follow up as quickly as possible with the most appropriate person. This is not a confidential referral; information from this referral may be used in our outreach to provide assistance. SuccessNet referrals are typically reviewed M-F during business hours. In the event of a life threatening situation, please contact Campus Safety at 260-982-5999.

Please fill out the following information and click Submit. All fields are required.

Pyramid of Intervention for Students (Click to learn more)

For Title IX Reporting,
please click here

Referred individual's first name:

Referred individual's last name:

Your first name:

Your last name:

Your e-mail address:

You are:

faculty
staff
a student
a parent
other

Please describe the identified problem or concern.

Please describe what has already been done to address the problem and the persons involved.

What, if anything, would you like SuccessNet to do?

Please select the most appropriate person to whom to submit the form. If you are not sure who that person should be, select the General Referral category. Referrals are reviewed by the SuccessNet team for appropriate follow up /intervention.