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Retention Referral

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An asterisk (*) indicates a required field.

Retention Referral

Campus

*Student Name

Jenzabar ID#

Class Name

Class Days and Time

Last date of attendance

*Recommendation(s):

Student should be counseled because of excessive absences:

Student should be counseled concerning unacceptable classroom behavior.

Student should withdraw because of poor academic performance.

Other action recommended

Comments concerning recommendation:

*Instructor Name

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Locations

Concordia Campus

2221 Campus Drive
Concordia, KS 66901

Geary County Campus

631 Caroline Ave.
Junction City, KS 66441

800-729-5101