Early Alert Form

Early Alert Form

Saint Mary-of-the-Woods College
The purpose of this form is for faculty and staff of SMWC to have a direct avenue to alert necessary campus personnel of any student concern.

This may be in the way of academic success, health or mental-health related concerns, behavioral issues, or any other concern that you may be made aware of that may disrupt the student's life or success at SMWC.

Once completed/submitted, this form will be sent to the appropriate campus personnel so we can provide the appropriate resources to the student of concern.

Please know that all concerns submitted will be taken seriously, and your concern and willingness to help provide the best experience for our students is an integral part of their student success.
Name of person submitting form.*

First NameLast Name
Today's date.*

MonthDayYear
Student that you are concerned about.*

First NameLast Name
Student classification at SMWC*

Campus StudentWoods Online StudentGraduate StudentOther
Student's ID number (if possible).
3. What is your relationship to the student you are filing this alert for?*

Academic AdvisorCampus Life StaffCoachFacultyInstructorProgram DirectorStaffSupervisorOther
Academic Concerns
4. Do you have academic concerns regarding this student? (Attendance, Major Concern/Gateway Issues, Missing Work, Academic Integrity, AI, Falsified Documents)*

YesNo
5. What academic concerns do you have regarding this student? Please select all that apply.*

Did not take required examExcessive AbsencesExcessive TardinessExtensive missed work/late workFailure to pass Gateway - must change majorLow test scoresNo book/access codeNo communication/responseAcademic Integrity (Plagiarism, AI, Falsified documents, ect.)Poor fit for major - Student major change possibleFalling short of 21st Century Scholar requirementsOther
6. What course or courses is this in regard to?*
8. How have you been able to address this with the student?*

EmailIn-personVirtual/PhoneOther
9. What response, if any, have you had from the student?*
10. Would you like us to send an Academic Warning Notice? This will notify the student they are at risk of failing without significant changes to behavior.*

YesNo
11. If you wish to report an academic integrity issue, please upload any evidence of academic integrity violation here.

Cancelof
12. Would you like us to send a FINAL Academic Notice? This will notify the student that they can no longer pass the course mentioned above. Please note: This can only be sent if the student has already been issued an Academic Warning Notice from a previous Early Alert. Once we send a FINAL Academic Notice, the student's grade will officially be entered as an F, and no grade change will be allowed.*

YesNo
Mental Health / Personal Concerns
13. Do you have mental health or behavior concerns regarding this student?*

YesNo
14. What mental health/personal concerns do you have regarding this student? Please select all that apply.*

Behavioral Concerns / Significant Changes in BehaviorDisability Support Accommodations (Testing, additional time, etc.)Grief SupportHospitalization / InjuryMental Health DisclosureSuicide IdeationOther
What is your email address? *
example@example.com
15. If there is a serious mental health or health concern for the student, when did this concern present itself?

MonthDayYear
Date
16. What has been your interaction with the student regarding your concerns?*
Athletic Concerns
17. Do you have any athletic concerns to report regarding this student?*

YesNo
18. What team is this student a member of?*

M. BasketballW. BasketballCross CountryEquineM. GolfW. GolfM. SoccerW. SoccerSoftballSprint FootballTrack and FieldM. VolleyballW. VolleyballCheer
19. What athletic concerns do you have regarding this student?*

Academic EligibilityAttendance IssuesBehavior ConcernsConcussion or other injuryNo longer on teamOther
Final Question
20. Please provide any additional details/information that will help us in providing support to this student.*
Should be Empty:

Early Alert Form

Academic Concerns

Mental Health / Personal Concerns

Athletic Concerns

Final Question