Student Contact Form

Personal Information:

*Today's Date:
*First Name: *Last Name:
*Email Address (must be a SEMO email address):
*Student ID number (SO Number):

Has your class attendance been consistent?
 Yes  No 

If not, please explain why in the box below:

*Are you having any difficulties or concerns with your classes?
 Yes  No 

If yes, please explain in the box below:

What type of difficulty or concern are you currently having with your class?
(Answer only if you said yes to the "Are you having any difficulties or concerns with your classes" question.) Please choose at least one of the following:

 Personal
 Financial
 Academic