Career & Academic Planning Services

Early Alert Reporting Form

Complete and submit this form whenever you have reason to be concerned about a student.

Faculty/staff member sending this report will receive follow-up information from a member of the CAPS department.
Reporting Instructor:
Reporting Instructor’s Email address:
Student’s First and Last Name:
Student’s Middle Name:
Student’s ID Number:
Student’s Mailing Address:
Student’s Phone Number:
Course Name and Number:
Student Advisor:
Reason(s) for report on this student:	Is not listed on the course roster Is receiving poor grades Has not submitted assignments Is not attending class Missed Exams Failed Exams
Action you would like the CAPS office to take:	Phone and email contact student Refer student to the Learning Center Refer student to their Academic Advisor Refer student to meet with instructor Refer student to meet with CAPS personnel
Other action to take:
Comments:
Please enter the following code:

Copyright © Chadron State College. All Rights Reserved.
Member, Nebraska State College System • CSC is an equal opportunity employer • Accreditation Information
Website Feedback
1000 Main Street, Chadron, NE 69337 • 1-800-CHADRON