First and Last Name Required NUID Required Husker Email Address Required Best phone number to reach you Required A case manager will call you to set up your appointment. Student Status Undergraduate Graduate Not currently enrolled What would you like to discuss in your appointment? General student support Medical Withdrawal Re-Enrollment after Medical Withdrawal Campus Process or Policy Navigation Post-Hospitalization Support Have you worked with SAS before? Yes No ZOOM REQUEST All meetings will be held in person (205 Louise Pound Hall) unless the student is unable to come to campus. Please check this box if you need the meeting to be via zoom. Who referred you to SAS? Required Any additional information you'd like the case manager to know in preparation for your meeting? Leave this field blank