Office of Retention Support Services

Volunteer State Community College | Student Services Division

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615.230.3390

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Faculty/Student Referral (To be completed by DSP Faculty)

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Student Name:
Student ID (V number) :
Faculty Name:
Class/Section:
Faculty E-Mail:
Please select the challenges from the following topics:
Lacks Essential Skills	No Class Participation
Subject Comprehension	No Motivation
Poor Time Management	Personal/Family Issues
Poor Study Skills	Incomplete Assignment(s)
Low Test Scores	Attendance (lack of)
Explanation or Other Concerns (please enter any explanation and the approximate course grade and/or any concers not listed above):