Early Warning Initiative : College of the Mainland

For COM Faculty

Purpose

In an effort to promote student success, College of the Mainland has created an Early Warning program which will be in the pilot stage during the fall 2008 semester. The goal of this program is to assist students in realizing their academic goals, explore their career options, and provide access to information regarding campus resources.

Early Intervention Referral Form

To refer a student to this program, complete the form online below or download and print the form and submit it to the Counseling Department.

Instructor Information

Class Course / Section #

Reporting Instructor Name

Instructor's E-mail Address

Office Extension

Student Information

Student Name

Student's E-mail Address

Student COM ID

Does the student know that you are making this referral?
Yes
No

Reason(s) for Referral (select all that apply)
Excessive Absences (Note number of absences in 'other' box below)
Academic Advisement
Study Skills Training
Not Turning in Assignments
Failing Grades
Has Not Accessed Online Class
Technical Issues
Difficulty in Online Environment
Other
If other, please explain:

Have you attempted to make contact with the student? If so, how? (select all that apply)
Face to Face Intervention
E-mail (Note date(s) of e-mails in 'comments' box below)
Telephone Call (Note date(s) of calls in 'comments' box below)
Letter (Note date(s) of letters sent in 'comments' box below)
No Intervention
Other
Comments regarding intervention:

Is there any additional information you think we should know?