This form will be submitted to the Academic Resource Center.

A staff member will review the submission and contact you, the student and any appropriate coaches or advisors. All check-marked information will be shared with the student. Additional confidential comments boxes are at the bottom of this form.  Please feel free to make comments about any area of concern in these boxes. The confidential information shared will assist staff in developing a clearer picture about the concerns you have to share without the student seeing these comments.

To ensure appropriate use of this form, users are required to login to the MyMarietta Portal.