EARLY WARNING FORM

Please fill out this form and select submit at the bottom of the page. Advisement Services will use the information to contact the student and encourage them to seek out available resources (whether it be tutoring or meeting with you, the instructor). You will receive a copy of any correspondence sent to the student.

Information you provide on this form may be shared with the student, who has legal access to this information. Observations should be objectively stated.

While this form is intended to reach students prior to the withdrawal date each semester, you may submit a form at any time. If you have any questions regarding the Early Warning System, please contact Sarah Keeling at sarahk@usca.edu or ext. 3541.
Instructor (full name):
Student Name :
Instructor's Email :
Date:
Course :
Section :
Please check any statements, that in your judgement, describe this student.
Student is missing classes:
Please select number of classes missed:
Student is habitually late:
Student is continually unprepared:
Student lacks essential skills:
Select area where student needs improvement.
Student is not completing reading and/or assignments:
Student struggles to keep pace with the class:
Student does not take notes in class:
Student does not participate in class:
Student is not performing well on tests/quizzes:
Student exhibits poor attitude and /or disruptive behavior:
Other