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First-Year Courses
521 Lancaster Avenue
CPO 65, Whitlock 455
Richmond, KY 40475
Phone: (859) 622-7322
fyc@eku.edu

FYC Student Information Request Form

Instructors may use this form to request additional information about a student such as contact information, course schedules, assigned advisors, or residence hall coordinators. This information can be used by instructors to reach students of concern or coordinate services between Student Success and academic units.

In cases where the student is a danger to her/himself or others, please contact the EKU Police Department immediately (phone: 859-622-1111). Please note that the SAIT form should be used to report students who appear to be troubled or troubling to elicit a response from University officials before the student's behavior reaches a crisis level.

Instructor Name: *

List your name here.

Instructor Email: *

Enter your email address here.

Course CRN#: *

Add the course CRN here.

Student Name: *

Add the student's name here.

Student Email Address: *

Add the student's email address here.

Student ID#: *

Add the student's EKU ID# (if known).

Please describe the nature of your concern: *

Help FYC find the resources you need by briefly describing why are you making this information request.

Has this student demonstrated troubled/troubling behavior?: *

Please let us know if the student has demonstrated troubled/troubling behavior.

If you answered "yes" above, have you filed a SAIT report?: *

If not, FYC will submit a SAIT report using the information you provide.

List any and all information you would like FYC to provide about the student: *

Let us know what information you need about the student.

Do you have any other questions or concerns at this time?: *

Feel free to ask any other questions or address any additional concerns that were not covered in the questions above.

Leave this field blank:

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