Early Alert Referral Form
Your First Name
Your Last Name
Your Northeast State Email Address
Student's First Name
Student's Last Name
Reason(s) for referral (mark all that apply):
Number of classes missed by student:
Is the missed attendance related to lack of childcare?
Poor Academic Performance
Once referred, please inform the student that he or she will need to go to The Learning Center.
Student Needs Project
Socioeconomic Needs (Food, Shelter, Transportation)
Assistance available through the Student Needs Project does not include direct financial payments of tuition/maintenance fees and/or textbooks/supplies.
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.
Please enter the course you are referring the student from:
(Example: ENGL 1100 - A01)
Further information/explanation of referral:
(Please note that your comments become part of the student's education records. FERPA applies to all information submitted.)