Early Alert

Institute for Extended Learning
   Early Alert Referral Form

This Early Alert Referral Form is part of the IEL's comprehensive Early Alert System, designed to identify students who may be at risk of academic difficulty or failure. This form allows staff, faculty (full- and part-time), advisors, and students to alert the appropriate counselor of any student who is not making satisfactory progress and/or is exhibiting behaviors that may lead to academic difficulty (e.g., non-attendance). Once a student is identified via the form below, the counselor and/or appropriate support service personnel will attempt to contact and work with the student in an effort to improve the student's academic performance and opportunity for success at the IEL. Simply complete the information below and submit online. If you don't know all of the information below, please provide as much information as you can about the student.

General Information:
Your Name: *
Your Status:
Your Email: *
Student First Name: *
Student Last Name: *
Student Campus ID:
Student Phone Number (if known): ()-
If this concern is related to a specific course please give the course number or title:

Areas of Concern
Please select the area(s) of concern and provide details on the selected item(s) in the box below:
Low class attendance:
Inappropriate classroom behavior:
Low test/quiz scores:
Incomplete/missing assignments:
Poor/underdeveloped study skills or time management:
Personal issues affecting student:
Other:
Please provide more detail on the selected item(s) in the space provided (up to 5,000 characters). As part of this information, we ask that you indicate which center(s) this student attends.
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