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Academic Intervention Report


By completing this form, you will be sharing your concern with LSU Staff members who are trained in responding to student needs. Thank you for sharing your concerns and making a difference in the LSU community. If you need to report academic misconduct, use the back arrow to select the correct form.



Disclaimer
Upon completion and submission, this form or information contained therein may constitute an educational record of any student(s) referenced, and is protected from disclosure except in some limited circumstances. As an educational record of a student, that student may have a right to review the form. The University will endeavor to maintain the information contained in the form as private, to the extent required and allowed by law. Questions regarding the form and its completion or use should be addressed to (ait@lsu.edu). The information contained in this form may be disclosed to appropriate University staff for evaluation and/or response including, but not limited to the following: LSU Police, Student Advocacy and Accountability, an academic college, Student Health Center, Disability Services, Residential Life, Academic Affairs, and/or the Center for Academic Success. This form must NOT be used to report emergencies.


 

IF THERE IS A POSSIBILITY THAT A STUDENT MAY HARM THEMSELVES OR OTHERS DIAL 911 IMMEDIATELY.
IN THE EVENT OF AN EMERGENCY, DO NOT USE THIS FORM.

CALL LSU POLICE IMMEDIATELY BY DIALING 911 OR 225-578-3231



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Background Information

 
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Email address must be of a valid format.
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Student(s) of Concern

Please provide as much information as possible regarding the student you are referring.

Involved party 1

Additional Information and Questions

I understand that this form must NOT be used to report emergencies.(Required)
This field is required.
Please identify any ACADEMIC PERFORMANCE concerns that you have about this student. Check all that apply:(Required)
You must make at least one selection.
If you are concerned about the student's attendance and/or absences from class, have you attempted to contact this student? If ‘No’, please attempt to contact this student prior to submitting this referral. If the student does not respond or if the response is concerning, please submit this referral promptly.(Required)
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Referral Source (Please select which most accurately describes you)(Required)
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Have you addressed these concerns with the individual?
This field is required.
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Has the student expressed any thoughts of withdrawing from the university?(Required)
This field is required.
Is the student aware of this referral?(Required)
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What's been the best method of communicating with the student?
This field is required.
Time-frame of concern:(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission