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Retention Form
Faculty and Staff: This Retention Form is to be used to report retention concerns you have about students. The Retention Intervention Team (RIT) monitors the alerts submitted and directs the appropriate resources and support to students of retention concern.

Please report urgent concerns of imminent harm to Officer Tony Maxison at 467-6408 or 911.

Questions? Ideas for improvement of this form? Contact Kendi Onnen at kendionnen@eureka.edu or 467-6303.

Email address *
Student Name *
Your answer
Your Name *
Your answer
What is your relationship to the student?
Check all that apply.
If you have the student in class, please enter the course ID.
Your answer
What specific concerns do you have about this student? *
Required
Please elaborate on your retention concerns about this student.
Your answer
What intervention steps (if any) have you already taken? *
Required
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