Early Alert System

Please Provide the following Information:

Your Name:

Office Phone: Your CCRI E-mail address:

Course #, Section #, and Title:

Campus:

Please inform us about the student for whom you have a concern and do not feel that you can provide the additional out-of-class support they need. We will contact them, share your concerns, provide an individual learning assessment and share our recommendations with you as well as a progress report at the midterm.

Student Name: Student ID#

Have you spoken to the student about your concerns? Yes No

Has Student completed prerequisite for course? Yes No

Intervention Recommended: Please Select One:

Please Check all that Apply.
Difficulty with Class Attendance	Difficulty with study habits and assignments
Student is constantly tardy Student consistently leaves class early Student consistently absent without contacting instructor Student has excessive absences	Student did not pass the first test Student continually submits substandard work Student did not turn in the first assignment Student does not turn in assignments regularly Student may have difficulty understanding assignments Student has low grades Student rarely/never participates in class
Personal Issues affecting class work and attendance	Difficulty with learning strategies
Student displaying a change in behavior Student experiencing a personal crisis, such a death in the family or serious injury Student sleeps in class Student exhibits poor attitude and/or disruptive classroom behavior Student reports problems at home	Student lacks essential skills; reading, writing, math Student does not read the text Student does not take notes Student does not organize assignments Student does not develop academic partnerships with classmates Student does not identify academic strengths and challenges Student does not perform well on tests
Additional Checklist for Advisors
Student is a single parent Student is working full-time while carrying more than a half-time course load Student has a history of repeating and withdrawing from classes Student has a history of repeating and withdrawing from this course Student has a history of withdrawing from courses when carrying a full course load Student is undecided about a major Student repeatedly changes his or her major