Instructions: Please complete this form for all peer advising contacts within 48 hours of your contact.
Peer Advisor Name:
Peer Advising Group:
Select Date of Contact:
Class Year of Advisee:
1) How did this advisee “find” you (check all that apply)?
*Other method advisee used:
2) Advisee’s concern (check all that apply):
3) Please provide a brief description of the advisee’s concern:
4) Please provide a brief description of your response:
5) Please indicate the action taken (check all that apply):
*Medical Care Referral Service (eg. "Dietary Consultation", "Sexual Health Care", etc.):
**Other action taken:
6) Did you feel prepared to advise this student?
*If “No” or “Somewhat,” please explain below:
7) Do you have any additional concerns/questions regarding this contact?
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Last update: March 1, 2011