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Early Alert Referral System Form


The Early Alert Referral Form is part of NPCC’s comprehensive Early Alert System designed to identify students who exhibit behaviors that could possibly lead to academic difficulty and failure.  Once a student is identified via this referral, the advisor and/or appropriate support service personnel will attempt to contact and work with the student in an effort to improve the student’s academic performance and opportunity for success at NPCC.  Simply complete the information below and submit online.  For more information, please contact Susan Millerd, 760-4163. Please email any supporting documentation to smillerd@npcc.edu.

Yes
No

Yes
No

Yes
No

Student is not attending class (indicate # of absences below)
Student exhibits poor attitude and/or disruptive classroom behavior
Student does not participate in class
Student lacks essential skills (indicate areas below)
Student has incomplete/missing assignments
Student appears to struggle to keep pace with the class
Student is attending class, but is not making satisfactory progress
Student shows signs of poor/underdeveloped study skills or time management
Student seems to have personal or medical challenges affecting their performance
Student appears to be dealing with mental health issues that are affecting performance
Other (use field below)

Reading
Writing
Math