Bluefield College > Immediate Alert Form

Student's First Name

Student's Last Name

Course Name:

Faculty/staff member submitting alert

Academic Concerns

Please select all that apply.

Difficulty with class attendance

Student has excessive absences

Student is consistently late

Student consistently leaves early without notification

Student is consistently absent without contacting instructor

Difficulty with study habits and assignments

Student did not pass first test

Student did not turn in first assignment

Student does not take notes

Student does not turn in regular assignments

Student has difficulty understanding assignments

Student has low grades

Student lacks participation in class

Difficulty with learning strategies

Student does not read text

Student does not organize assignments

Student does not identify academic strengths and weaknesses

Personal issues affecting class work and attendance

Changes in behavior

Constant state of crisis

Student sleeps in class

Problems at home, babysitting, work schedules changes, etc.

Crisis in effect, i.e., death in family, serious car accident, etc.

Texts or uses cell phone during class

Please select concerns that you are aware of that are non-academic. Please check all that apply.

College Adjustment Issues

Financial Problems

Physical Health Concerns

Mental Health Concerns

Alcohol or Substance use concerns

Roommate difficulty

Disruptive behavior

Absent from work

Spiritual concerns