Student Referral Program

Please fill out the below information to the best of your ability. 

Please be aware that this does not constitute filing an official police report. To file an official police report, please contact the University of Massachusetts Boston Department of Public Safety at 617-287-1212. For incidents occurring off-campus in the City of Boston, please call 617-343-4730.


Please be aware that all reports, including anonymous reports, regarding alleged discrimination, harassment, sexual or gender harassment, domestic or dating violence, stalking or retaliation pursuant to the Equal Opportunity Discrimination and Harassment Policy and/or the Student Code of Conduct need to be submitted under the ODEI Complaint Form found here.
Background Information
This form is for the use of current students, faculty, or staff from the University of Massachusetts Boston. Please provide detailed information regarding the academic concern you are reporting.

Use this form if you have been unsuccessful in resolving an issue on your own. Once the form is submitted, the student's academic advisor will review the information and take appropriate action. 

As the Student Referral Program does not respond to emergencies, the report may not be reviewed and/or immediate action taken on the same day it is submitted. If you have any questions related to completing this form, please call the University Advising Center at 617-287-5500.
Referrer Information

Student Information

Please include all 8 digits, including leading 0s

In addition to this referral, we suggest that you attempt to discuss the issue with the student.

Supporting Documentation

Click the button below to submit this referral to the student's advisor. A copy of your submission will be sent to your email (at the address you provided above).