Please complete the form below to make a referral to the MODIFY Program.

If you have trouble accessing this form, please contact Allison Messer (

If you do not hear from a MODIFY specialist regarding your referral within one week, please call Alison Messer at 304-205-6424 for assistance.

Fall Semester Enrollment

  • Referral Deadline: June 1
  • All paperwork in: July 1

Spring Semester Enrollment

  • Referral Deadline: Oct. 1
  • All paperwork in: Nov. 1

Summer Session Enrollment

  • Referral Deadline: Mar. 1
  • All paperwork in: Apr. 1
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