ASAP Referral (Academic Success & Achievement Planning)

Thank you for taking the time to share your concerns regarding a School of Pharmacy student.

Once your referral is received, the Director of Student Success will review the information and may contact you for additional information.  Please note submissions are monitored Monday through Friday between 8:00 am and 5:00 pm.

This form is not for acute or crisis situations. Please utilize UMatter and submit a CARE report here: https://umatter.olemiss.edu/ Please also notify Dr. Kristen Pate, Associate Dean for Student Affairs, if this is a crisis situation at, kpate@olemiss.edu, or (601.807.0860).

If you would like to refer a student to Sophie Kollin, our Pharmacy Wellness Counselor, she can be reached at: pharmwellness@olemiss.edu, or by calling 662.915.7385.

If this is an emergency, please call University Police (662.915.7234) or 911.

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Faculty or Staff Member Information
Your first name: *
Your last name: *
Your position/title:
Your phone number: *
Your email address: *
Student Information
Student first name: *
Student last name *
Student ID Number (if known)
Student Email address:
Reason for submitting ASAP Referral
Please share any information you think would be helpful.
 *
Have you spoken with or attempted to speak with the student about your concern? *
Concerning Behavior (Please select all that apply.) *
Required
Please provide any additional information you think would be helpful in assisting the student.
If this is related to a specific course, please list course name.
Please list course number.
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