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Faculty and Staff Referral Form

Thank you for making a referral on behalf of a student. The purpose of the Faculty and Staff Referral form is to provide faculty and staff a way to refer students who need assistance. Student Affairs desires to be a centralized resource to make sure students have access to and information about the services available here at FXUA. When a student is referred, Student Affairs will contact the student to further assist with his/her needs. The appropriate follow-up measures will be taken.

In the event Student Affairs needs to follow-up with you or to ask you questions, this form must contain your name and email address. For this to be a collaborative process, make sure the student is aware the referral is being made.

If you have any questions, please contact Student Affairs Manager, at

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