Bishop State Community College
EARLY ALERT SYSTEM
STUDENT PROGRESS REPORT AND REFERRAL FORM
STUDENT’S NAME_________________________________ STUDENT’S #____________________
INSTRUCTOR: ___________________________ COURSE NAME/NUMBER____________________
1. Check all items that pertain to the student’s academic difficulty in your class.
Item Satisfactory Unsatisfactory Comments
A. Student’s class attendance. ( ) ( ) ____________________
B. Student’s participation in
discussion/class activities. ( ) ( ) ____________________
C. Student’s completion of
class assignments. ( ) ( ) ____________________
D. Student’s utilization of
your office hours. ( ) ( ) ____________________
E. Student’s preparation for
class, exams, quizzes etc. ( ) ( ) ____________________
F. Student’s background in ( ) ( ) ____________________
subject, i.e., prerequisites met.
2. What steps have you taken regarding this matter?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3. What would you recommend to the student to do better in your class?
( ) improvement in study skills/time management ( ) improve attendance
( ) utilization of peer tutoring ( ) drop the course
( ) student/instructor conference ( ) talk w/counselor
( ) other specify_______________________________________________________________________
4. I have discussed this report with the student. ( ) Yes ( ) No Date________________
5. Last date of attendance____________________
_______________________________ ____________________________
Instructor’s Signature Date