This form is intended for use of referring students for case management services provided
by the Health and Wellness Case Manager.
Any person can complete and submit the referral to Health and Wellness Case Management
Please complete this form completely and submit to the Health and Wellness Case Manager.
If you have any questions or need assistance completing this referral form please
contact the Health and Wellness Case Manager.
It is recommended, but not necessary, that this referral is completed collaboratively
with the student.
Please inform the student that a referral has been submitted on their behalf to promote
prompt access to services.