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Academic Alert Form

Introduction Here

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Please alert us of any student in your class who is having academic difficulty.  Thank you!

STUDENT NAME
LAST 4 DIGITS of ID:
CLASS/SECTION 
INSTRUCTOR
PHONE
   

Would you like feedback on this student?

ATTENDANCE
Has never attended
Poor or sporadic attendance
Attendance is Satisfactory

ACADEMIC
Low class average
Assignments not Submitted

RECOMMENDATIONS
Refer to ASC for tutoring    
Refer to CAPS for counseling 
 Advise student to withdraw   
Other (See comments below.)

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