Student Referral Form

This form is for students who may have any questions or concerns about maintaining satisfactory academic progress, readmission, retroactive withdrawals (or leave of absence), taking an excess of 18 credits, or to appeal the determination of ineligibility for financial aid. An OSAS staff member will respond to your inquiry via email. Please give the OSAS staff 7-10 business days to respond to your inquiry.

Please fill out the form below to the best of your ability. We will try our best to help you.

E-Mail Address

Cell Phone Number This number will be used by our office if we are unable to reach you via email.

CUNYFirst Empl ID

Date of Birth Date of Birth

First Name

Last Name

Year of Study

Major If you have yet to decide on a major, select 'Undecided'.

Issue/Concern If your concern isn't listed, select 'Other' and write your issue in the comment field.

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