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		Early Alert Form The Early Alert System is a program designed to help student improve academic performance. This program allows professors to alert the Academic & Career Center of any student who is not making satisfactory progress. The referral form below provides an easy method to refer students to the program. Once a student is identified, the A & CC will contact him or her in conjunction with referrals to other support services in an effort to improve classroom performance. Please fill out the following information and click the "Submit" button at the bottom off the page. Instructor: Email: Course Title : Course Number: Name of Student Referring: Course Section Student's ID Number:     Student's Phone Number (Optional):     Area(s) of Concern (Please click on the button that best answers each question.) 1. Is attendance a problem?:   Yes No     If yes, how many classes has the student missed ?   1 2 3 or more 2. Low test scores?  Yes No     If yes, how many quizzes or test remain for the semester? 1 2 3 or more 3. Assignment Completion? Yes No 4. Study skills?  Yes No 5. Other (please specify) 6. Additional comments

5.9.2008

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