School of Nursing EMBRACE Referral Form

CSUF School of Nursing

EMBRACE
Student Referral Form

Referrals should only be initiated after discussion with the student. This referral process is intended to help us match students with needed resources and is not anonymous.

Before You Begin:
If this is an emergency that requires immediate attention, dial 9-1-1 or contact University Police at (657) 278-2515. This form is NOT designed as an emergency response notification.

Student Being Referred:

Student CSUF Email Address:

Referrer Name:

Urgency of Request:

Information sharing / consultation request
On going concern
Serious but not emergency or crisis level

Primary Reason(s) for Referral:

Nurse Coach (manage educational challenges, time and stress management, life-balance, and referrals to campus resources)
Learning Specialist (address learning needs, discuss learning strategies, and assist with referrals including DSS)
Writing Center (writing skills)
Nursing Career Coach (resume assistance, mock interviews, etc.)
Peer Mentoring Program (additional peer support)
Nursing Advising Center (University and nursing policies, financial aid, registration, study plan, etc.)
Other (provide details below)

Additional Details:

Confirmation of Discussion with Student:

I have discussed this referral with the student and the student is expecting a follow-up email from the School of Nursing.