Early Warning Form

The red asterisk indicate required fields.

Student Name:*	Student's ID #:*
Student Email:*	Major:
Course Title:*	Instructor's Name:*
Instructor's Office:	Instructor's Email:*

Dear Student:

The Student Early Warning Form is designed as a tool for faculty and advisors to identify specific students who are not making sufficient academic progress so they can work with those students to try to remedy the situation. There are indications you are having some difficulties with this class. If things continue as they are, your final grade will be in the range. In particular, I am concerned about:

Comments:

Because I want you to be successful, I want to assist you in overcoming these difficulties. Please provide me with the reason(s) as to why you think you are having trouble. Please complete the form and arrange to meet with me no later than . For your information, I am also sending your academic advisor a copy of this form.

Reason(s) for my difficulties include (please check all that apply):

Lack of class attendance	Too many job responsibilities
Family/Personal responsibilities	Lack of transportation
Inadequate study skills	Lack of understanding of course materials
Lack of financial support	Other (please specify)

Comments:

University Division

Early Warning Form