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Academic Alert Form

Faculty & Staff

If a student is doing unsatisfactory work in your course or behaves in ways that cause you concern, please check the appropriate boxes below. Indicate whether or not you wish action to be taken or if you intend for the information to be advisory only.
Student Name
Course Name & Course No.
Academic Concerns
Excessive Absences Lack of Engagement Poor Examination Skills
Struggling with Material Missing Exam(s) Poor Language Skills
Poor Preparation Missing Homework Time Management

Non-Academic Concerns
Please Specify :

Please specify:
Red Dot
Have you attempted to contact the student
regarding your concerns?
Can the student still complete the course successfully?
Yes No Yes No
If so, please describe what you conveyed:
If so, how?
Do you recommend action be taken? Red Dot Faculty Information
Yes No Name:
If yes, do you have suggestions?
Phone No: (Example: 9999)