Parent Referrals
If you have a concern about your student, please share below as much information as possible. The Office of Student Engagement and Success will reach out to your student and see how we can assist.

IMPORTANT: Unless your student has granted you access to his/her educational records via the "Consent to Release Student Information" form, we may not be able to share with you what we learn from your student. FERPA (Family Educational Rights and Privacy Act) is a federal law that affords students certain rights with respect to their education records. More information can be found here: www.murraystate.edu/FERPA.

Your student can access the "Consent to Release Student Information" form by logging into myGate, clicking the Academics tab, and the link is located in the box labeled Student Links.

What is your (parent) first and last name?
Your answer
What is your (parent) e-mail address?
Your answer
What is the best phone number to use in order to reach you (parent)?
Your answer
What is your student's first name? *
Given first name - no nicknames, please
Your answer
What is your student's last name? *
Your answer
What is your student's e-mail address?
Your answer
What is your student's cell phone number?
Your answer
Is your main reason for contacting us: Academic Concerns? *
Please mark the most appropriate categories.
Required
Is your main reason for contacting us: Personal Issues? *
Please mark the most appropriate categories.
Required
Is your main reason for contacting us: Financial Issues? *
Please mark the most appropriate categories.
Required
Briefly tell us more information regarding your reason for contacting us. *
This will help us better understand the situation before we contact your student.
Your answer
Have you already discussed this issue with your student?
Has your student indicated an intent to leave MSU?
Would you like your student to know that you have contacted us? *
Your response does not affect our ability to reach out to your student. We will act on this Referral regardless of your answer to this question.
Would you like a follow-up contact from the Retention Office?
Please see the important FERPA note at the beginning of this form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Murray State University. Report Abuse - Terms of Service - Additional Terms