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Referral to SPC RISE (for caregivers & administrators)

If a student or young adult you know is interested in attending St. Petersburg College and joining the RISE program, please fill out this referral form on their behalf and the RISE Program Coordinator, Dr. Althea Blake, will reach out to you within 24 hours to schedule an appointment.  

Thank you for your interest!

Student Information

1
What is the student's name? 
2
What is the student's email address?
3
What is the student's telephone number?
4
What is the student's prospective major?
5
In what county does the student reside?
6
Has the student already completed an application to SPC?
7
Please provide any additional information about the student. 

Referral Source

8
What is the name of the individual referring the student to the RISE program.
*9
What is the email address of the referral source?
10
What is the phone number of the referral source?
11
What is the relationship between the student and the referral source?
12
Would you like to be involved during the introduction meeting between the RISE program coordinator and the student? 
*13
How did the referral source hear about RISE? 
 

If you have comments about this survey or questions regarding how to complete this survey, please contact Althea Blake at Blake.Althea@SPCollege.edu or call 727-614-7002.

The Board of Trustees of St. Petersburg College affirms its equal opportunity policy in accordance with the provisions of the Florida Educational Equity Act and all other relevant state and federal laws, rules and regulations. The college will not discriminate on the basis of race, color, ethnicity, religion, sex, age, national origin, marital status, pregnancy, sexual orientation, gender identity, genetic information, or against any qualified individual with disabilities in its employment practices or in the admission and treatment of students. Recognizing that sexual harassment constitutes discrimination on the basis of sex and violates this Rule, the college will not tolerate such conduct. Should you experience such behavior, please contact the Title IX Coordinator and EEO Officer at 727-341-3055; by mail at P.O. Box 13489, St. Petersburg, FL 33733-3489; or by email at eaeo_director@spcollege.edu or spctitleix@spcollege.edu.