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Faculty/Staff Information
*Your First Name:
*Your Last Name:
*Your E-mail:
*Term:
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Fall 16-Week
Fall 8-Week I
Fall 8-Week II
Spring 16-Week
Spring 8-Week I
Spring 8-Week II
Summer 10-Week
Summer 5-Week I
Summer 5-Week II
*Year:
Students’ Information
*Student First Name:
*Student Last Name:
*Course Name:
Reason for Early Alert: (check all that apply)
Poor Attendance
Consistent Tardiness
Missed Assignments
Late Submissions
Poor Quality of Work
Lack of Motivation
Inadequate computer skills
At risk of failing course
Time Management Skills
Family Concerns
Medical/Mental Health
Financial Concerns
Housing Concerns
Other...
Faculty Intervention: (check all that apply)
Conferenced
Laptop Request
Referred student to campus resource
Communicated via e-mail, phone, or Zoom/Teams
Recommendations/Desired Results: (check all that apply)
Tutoring
Study Skills Assistance
Referral to Disability Services
Career Counseling
Contact Professor
Contact Advisor
Counseling Services Referral
Withdraw from Course
Technology Support
Food Pantry Referral
Talk with student
Keep on file for record
Additional Comments:
Student First Name:
Student Last Name:
Course Name:
Reason for Early Alert: (check all that apply)
Poor Attendance
Consistent Tardiness
Missed Assignments
Late Submissions
Poor Quality of Work
Lack of Motivation
Inadequate computer skills
At risk of failing course
Time Management Skills
Family Concerns
Medical/Mental Health
Financial Concerns
Housing Concerns
Other...
Faculty Intervention: (check all that apply)
Conferenced
Laptop Request
Referred student to campus resource
Communicated via e-mail, phone, or Zoom/Teams
Recommendations/Desired Results: (check all that apply)
Tutoring
Study Skills Assistance
Referral to Disability Services
Career Counseling
Contact Professor
Contact Advisor
Counseling Services Referral
Withdraw from Course
Technology Support
Food Pantry Referral
Talk with student
Keep on file for record
Additional Comments:
Student First Name:
Student Last Name:
Course Name:
Reason for Early Alert: (check all that apply)
Poor Attendance
Consistent Tardiness
Missed Assignments
Late Submissions
Poor Quality of Work
Lack of Motivation
Inadequate computer skills
At risk of failing course
Time Management Skills
Family Concerns
Medical/Mental Health
Financial Concerns
Housing Concerns
Other...
Faculty Intervention: (check all that apply)
Conferenced
Laptop Request
Referred student to campus resource
Communicated via e-mail, phone, or Zoom/Teams
Recommendations/Desired Results: (check all that apply)
Tutoring
Study Skills Assistance
Referral to Disability Services
Career Counseling
Contact Professor
Contact Advisor
Counseling Services Referral
Withdraw from Course
Technology Support
Food Pantry Referral
Talk with student
Keep on file for record
Additional Comments:
Student First Name:
Student Last Name:
Course Name:
Reason for Early Alert: (check all that apply)
Poor Attendance
Consistent Tardiness
Missed Assignments
Late Submissions
Poor Quality of Work
Lack of Motivation
Inadequate computer skills
At risk of failing course
Time Management Skills
Family Concerns
Medical/Mental Health
Financial Concerns
Housing Concerns
Other...
Faculty Intervention: (check all that apply)
Conferenced
Laptop Request
Referred student to campus resource
Communicated via e-mail, phone, or Zoom/Teams
Recommendations/Desired Results: (check all that apply)
Tutoring
Study Skills Assistance
Referral to Disability Services
Career Counseling
Contact Professor
Contact Advisor
Counseling Services Referral
Withdraw from Course
Technology Support
Food Pantry Referral
Talk with student
Keep on file for record
Additional Comments:
Student First Name:
Student Last Name:
Course Name:
Reason for Early Alert: (check all that apply)
Poor Attendance
Consistent Tardiness
Missed Assignments
Late Submissions
Poor Quality of Work
Lack of Motivation
Inadequate computer skills
At risk of failing course
Time Management Skills
Family Concerns
Medical/Mental Health
Financial Concerns
Housing Concerns
Other...
Faculty Intervention: (check all that apply)
Conferenced
Laptop Request
Referred student to campus resource
Communicated via e-mail, phone, or Zoom/Teams
Recommendations/Desired Results: (check all that apply)
Tutoring
Study Skills Assistance
Referral to Disability Services
Career Counseling
Contact Professor
Contact Advisor
Counseling Services Referral
Withdraw from Course
Technology Support
Food Pantry Referral
Talk with student
Keep on file for record
Additional Comments:
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