Injury and Illness Claims
- Injury and Illness Prevention Program
- Incident Reporting Form – Handwritten forms are no longer accepted. You must use a PDF editor such as Adobe Reader to complete this form.
- Workers’ Compensation Insurance
Student Accident Claims
Do not send to the Hartford address displayed on the form. Contact information for student accident insurance claims is available on the Student Insurance page.
- Health Sciences Retention Coordinator
- ACC Early Alert Referral System (EARS)
- Counseling Services (Mental Health and Crisis Intervention)
Progressive Discipline Process
- Exit Interview Checklist
- Exit Interview Notes
- Exit Review
- Re-entry Form
- HITT Early Alert Deficiency Notification
- Student Complaint Procedures
- Report an Incident (submit a formal complaint related to college services, classroom instruction, or grade disputes)
It is not necessary to send the actual flu shot record for each student. For your programs, please attest to students receiving flu shots who have been on site on or after September 1, 2020. This includes students who were welcomed on site earlier in the year, but were still there after September 1 when the flu shot requirement went into effect.
The Ascension Flu Vaccine Attestation Form should be sent to your respective Ascension program contact: the individual who usually process the placements/schedules/attestations for your program. For example, the Surgical Technology, ADN, EMT, and Paramedic students are all processed through Kristin Milliorn.
Ascension only needs attestation of the flu shot once per flu season (September 1 – March 31). For students coming on site (for the first time or repeats) in Spring, the flu vaccine attestation should be included in the main attestation form. If it is not, you can use the form as a supplement for any new students not captured in the Fall.
- FERPA Website
- FERPA Consent for Release of Student Information (for department meeting with student and their guest)
- FERPA Consent for Release of Confidential Information (for Student Services)
- Student Reference Request, FERPA Release and Release of Liability
- Student Proxy Authorization Form
Contact: Dianne Olla
- Phone: 223.7647
- Email: firstname.lastname@example.org
Please see Karoline Gebert before submitting your schedule.