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EARLY ALERT NOTICE
Date (mm/dd/yyyy)
The Early Alert Notice is designed to identify students who may be having academic or personal
difficulties, putting their success as students at risk. It is appropriate to refer a student at any time
during the semester.
When a referral is received in the Student Affairs Office, a staff member will follow up with the
student and help connect the student with appropriate support services. The referring faculty
member and the student's faculty advisor will be informed of action taken to assist the student.
Thank you for your proactive assistance with the early identification of students who are doing
poorly in class or experiencing other kinds of problems that affect academic performance.
Instructor's Information
Instructor's Name
Instructor's Email
Instructor's Phone Number
Student/Course Information
Student's First Name
Student's Last Name
Student's Phone Number (if available)
Course
Please check any statements that, in your judgment, describe this student:
Student has excessive absences. (please provide in the box below approximate # of absences and last date of attendance)
Student lacks essential skills. (explain below)
Student is not completing reading and homework assignments.
Student is not performing well on tests.
Student appears to struggle to keep pace with the class.
Student is attending, but not participating in class.
Student struggles with time management and organization.
Student continually submits sub-standard work.
Student appears to be struggling with personal and/or medical matters.
Student exhibits poor attitude and/or disruptive classroom behavior.
Student is unsure about continuing at Concordia and may be planning to leave.
Other (explain below)
Please provide additional information about items checked above or other concerns and recommendations.
Note: If you have additional concerns that you would prefer not to include on this form, call the Student Affairs Office at 299-3455.
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