Student Referral Form

Please use this form if you are concerned about a student or feel that they could benefit from accommodations. If this is an emergency, please call USC PD at (803) 777-4215 or call 911.

Referral Form

*Required fields

Your First and Last Name

Your position/title or relationship to the student

Your phone number

Your email address

Student of Concern

Name of Student *

Is this a self-referral?

Gender of Student

USC ID Number of Student

Begins with a letter (EX: A123456)

Date of Birth of Student

(MM-DD-YYYY)

Phone Number of Student

Email Address of Student

Please provide a description of the incident/behaviors you have observed. Please use specific, objective, and concise information. Please email sadrc@mailbox.sc.edu if you have any additional questions or concerns.

Would you like to be contacted by a member of the SDRC team?

Student Disability Resource Center

Student Referral Form

Referral Form

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