Attendance Referral Form

This form is intended for LSUE instructors to submit when a Pathways to Success student has been absent or late to a class.

IMPORTANT: This form should be submitted immediately following the absence so that the Student Success Center staff can reach out to the student and intervene before the maximum number of absences or late arrivals result in failure of the course.

Instructor Prefix:*

Instructor First Name:*

Instructor Last Name:*

Instructor Email Address:*

Student's First Name:*

Student's Last Name:*

Student's LSUE Email Address:*For example: 102345@mail.lsue.edu

Course and Section:*For example: MATH0001-01

Term:*

Date #1 of Absence:*

Instructors should always try to submit Pathways to Success absences immediately after they occur. However, if there are additional absences for this student that need to be submitted, please do so below.

Date #2 of Absence:

Date #3 of Absence:

This form only allows the submittal of a maximum of three (3) dates. If the student has missed more dates, please submit the form a second time with those additional dates.

Disclaimer: The absence interventions conducted by the Student Success Center are meant to be preventative, so timely reporting of student absences immediately after they occur is strongly recommended.

Student Success Center

P.O. Box 1129
2048 Johnson Hwy
Science Building, Room 146
Eunice, LA 70535

Phone: 337-550-1206
Email: studentsuccess@lsue.edu