EARLY ALERT NOTIFICATION
STUDENT NAME: ___________________________ SUSLA ID: 9000 DATE: __________
STUDENT ADDRESS: ____________________________________________________________________
STUDENT EMAIL ADDRESS: ______________________ TELEPHONE #: ____________________________
REASON FOR REFERRAL: (Please check all that apply)
Course Name:
Course Section:
Instructor:
Never Attended Classes
Excessive Absences
Poor Performance
Other: Please describe below:
PLAN OF ACTION
1. INSTRUCTOR CONTACT TYPE: Telephone Email Letter Office Visit
Action taken from Contact (date & time):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2.
DIVISON CHAIR CONTACT TYPE: Email Letter Office Visit
Action taken from Contact (date & time):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Upon completion of Division Chair Contact, please forward to the Office of Student Retention by
February 15, 2016 (1
st
Reporting Date) and March 15, 2016 (2nd Reporting Date).
Revised 01/26/2016
OFFICE OF STUDENT RETENTION
3. RETENTION OFFICER CONTACT TYPE:
Email Letter Office Visit
Intervention Strategy:
Referred to University Counselors Referred to Tutor Advised to Drop Class
Action taken from Contact (date & time):
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
End of Semester Review:
Student Passed Course Student Failed Course Student Dropped Course Student Withdrew from University
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