Student Concern Alert Program for Student Success Student ID Number*Student Name* First Last Date of Notification*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's Classification*First Year ExperienceFreshmenSophomoreJuniorSeniorCLIMB StudentCourse Identification*Please include course name and section. | i.e. IDS 115-02|Faculty Name*Have you met with the student regarding their academic standing?* Yes No Please check one or more of the following reasons for referring the student:* Student has excessive absences and/or tardiness Student has never attended class Knowledge of personal or family difficulties Student's work is not meeting expectations of the course Poor engagement/participation in class Leaves class early and/or arrives to class late Missed quizzes, exams and/or assignments Lack of organization in coursework Lack of essential skills (i.e. reading, writing, math) Student has threatened to withdraw Other: Please list/describe any additional information below to help us better accommodate the student.*
