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Center for
Student Academic Success

C-SAS Early Alert

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This form is to be utilized by professors, advisors, and/or work supervisors, who are concerned about a student’s academic progress and/or personal well-being. We encourage faculty and staff to refer students EARLY IN THE QUARTER (first 3-4 weeks of the quarter are critical) and as soon as detrimental behaviors are displayed. For example:

1-2 missed classes
1-2 missed assignments
1-2 failed quizzes
1 failed test

This information will be used by the CSAS staff to make contact with the student and devise a plan of action for improved academic progress. Please be advised that referral information will be shared with the student. ¹ ²

Date:
Faculty/Staff Name:
Faculty/Staff Email:
Student’s Name:
Student’s LSU ID # (if known):
*Is this concern related to a specific course?		yes no
		If yes, please specify the course:

Please check all statements that relate to the area(s) of concern you have identified.

Student:

	Lacks fundamental skills in: reading writing math
	Is not completing reading and/or homework assignments.
	Continually submits sub-standard work.
	Appears to struggle to keep pace with the class.
	Does not take notes in class.
	Is not attending class.
	Does not engage in class activities or class content.
	Is not performing well on tests.
	Exhibits poor attitude and/or disruptive classroom behavior.
	Appears to be working too many hours during the week.
	May be experiencing personal struggles that prevent adequate performance in class/work.
	May be struggling with an addiction: drugs alcohol video gaming other
	Is experiencing financial hardship.
Other:	Please explain.
	Clarification of items checked above:
	\|

1 Lake Superior State University, Early Alert Referral System for Faculty and Advisors Office of Advising and Retention

2 Columbus State University, Early Alert Program Referral Form

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