Student Referral System

Your First Name Your Last Name

Your Northeast State Email Address

Your Office/Department


Student's First Name Student's Last Name

Student ID

Do you believe the student is active military or a veteran?
Do you have an accommodation letter from Accessibility Services on file for this student?
Is the student a dual enrollment student?
Reason(s) for referral (mark all that apply):

  • Number of classes missed by student:
  • Is the missed attendance related to lack of childcare?

  • Once referred, please inform the student that academic support services and free tutoring are available in The Learning Center.

Student Needs Project
  • Assistance available through the Student Needs Project does not include direct financial payments of tuition/maintenance fees and/or textbooks/supplies.
Personal Counseling
  • Please contact Counseling Services at 423.323.0211, on-campus extension 3211, or email to initiate a counseling referral. Do not comment in the box below.
  • When students verbally express or write a direct threat to harm self or a direct threat to harm others immediately call Campus Police at 423.677.7927.

Further information/explanation of referral: Please do not include accessibility or counseling referrals in your comments. See Accessibility Services or Counseling Services contact information above. Please note that your comments become part of the student's education records. FERPA applies to all information submitted.