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Health Science Success Coordinator Referral Form - Luis Garza
All information provided on this form will be sent directly to the Health Science Success Coordinator, Luis Garza. All information will remain confidential.
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1.
ACC Email Address
(Required.)
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2.
Name
(Required.)
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3.
Student eID
(Required.)
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4.
Academic Program
(Required.)
Associate Degree Nursing
RN-to-BSN
Vocational Nursing
Allied Health Science Courses
Dental Hygiene
EMT
Paramedic
Health Information Technology
Medical Laboratory Technology
Phlebotomy
Occupational Therapy Assistant
Pharmacy Technician
Physical Therapist Assistant
Radiologic Technology (Technologist)
MRI
Cardiovascular Interventional Technology
Computed Tomography
Medical Vascular Sonography
Cardiovascular Sonography
Surgical Technology
Veterinary Technology
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5.
Course Information--Please provide all the course information you are having concerns with. Please provide the course name, section number, and Professors' name. Example: RNSG-1160 (001); Professor Little.
(Required.)
6.
Primary Campus
Highland
Cypress Creek
Eastview
Elgin
Hays
Round Rock
Other (please specify)
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7.
What are your reason(s) of concern?
(Required.)
Attendance
Child Care Issues
Communication Skills
Economic Related Issues/Financial Concerns
English Language Skills
General Anxiety
Return to Program
Test Taking Skills
Time Management Skills
Transportation Related Issues
Grades
Other (please specify)
Contact Information:
Luis Garza, M.Ed
Health Science Success Coordinator
East View Campus - Room 9407
512-223-5780
Round Rock Campus - Room 3105
512-223-0223
lgarza12@austincc.edu