Early Alert Form

Academic Success Center | Early Alert Form

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Early Alert Form

The purpose of the Early Alert System is to help students at Lander be successful. The form below allows faculty or staff to alert the Academic Success Center of any student who is not making satisfactory progress. Please fill out the appropriate sections below and submit it. The information will go directly to the Academic Success Center faculty and staff for immediate attention. Feedback will follow your request.

1.	Student's name:*

2.	Lander ID #:*

3.	Course:*

4.	Instructor or Advisor*

5.	Instructor/Advisor E-mail:

6.	Instructor/Advisor Phone #:

7.	Excessive absences or tardiness?:
	YesNo

8.	Low grades (please list):

9.	Student needs to see a Wellness Center counselor?:
	YesNo

10.	If yes, please state the reason for your concern:

11.

Student needs a tutor:

For the course only

Writing tutor for non-english course

Math tutor needed for non-math course

Other, please specify

12.	Student exhibits disruptive behavior?
	YesNo