Academic Alert Form If a student is doing unsatisfactory work in your course or behaves in ways that cause you concern, please check the appropriate boxes below. Indicate whether you wish action to be taken or if you intend for the information to be advisory only. When the form is complete, click the [Submit] button at the bottom of the page. The form will be submitted to the Dean's Office and the Registrar. You'll also see a completed version of the form, which you may print for your records. Student Name: Course Name and Number: Academic Concerns Excessive Absences Struggling with Material Inadequate Preparation Lack of Engagement Missing Exam(s) Missing Homework Poor Examination Results Poor Writing Skills Poor Language Skills Time Management Lack of Familiarity with U.S. Teaching Methods Other: Non-Academic Concerns Please Specify: Actions Have you attempted to contact the student regarding your concerns? Yes No If so, please briefly describe what you conveyed: Can the student still complete the course successfully? Yes No If so, how? Do you recommend action be taken? Yes No If action is recommended, do you have suggestions? Your Name: Telephone Number: Email Address: