Early Alert Referral Form

Your First Name Your Last Name

Your Northeast State Email Address

Your Office/Department


Student's First Name Student's Last Name

Student ID

Reason(s) for referral (mark all that apply):

  • Number of classes missed by student:

  • Once referred, please inform the student that he or she will need to go to The Learning Center.

Student Needs Project
  • Assistance available through the Student Needs Project does not include direct financial payments of tuition/maintenance fees and/or textbooks/supplies.
Personal Counseling
  • When students verbally express or write a direct threat to harm self or a direct threat to harm others immediately call Campus Police at 423.677.7927.

Further information/explanation of referral: (Please note that your comments become part of the student's education records. FERPA applies to all information submitted.)