Student Affairs - Forms

Students of Concern Referral

Early Alert Warning System

Students of Concern is an Early Alert Warning System designed to serve as a point of referral from faculty and staff who have identified students who are experiencing difficulty in their collegiate experience and as a result, are at risk of leaving the institution. Once a student has been referred, the Students of Concern Committee is responsible for identifying the College representative best positioned to intervene and assist the student. The Committee is charged with coordinating the support resources of the College to assist referred students in: maintaining satisfactory academic progress; getting connected to appropriate resources; becoming engaged in the campus community, and; maintaining their overall health and well-being.

1.Name and Referring Community Member
*
2.Phone
*
3.Email Address
*
4.Contexts in Which You Know Student

Check all that apply: *
Classroom
Advisor
Student Group
Athletic Team
Residence Life
Chaplain’s Office
Office of Student Activities
Wellness Center
Other (please specify)
5.Student Name
*
6.Age
*
7.College Status*
Freshman
Sophomore
Junior
Senior
Graduate Student
Don't Know
8.Area of Study/Major
*
9.Student’s Living Situation*
On-Campus
Off-Campus
Spouse/Partner
Parents
Roommate
With Child(ren)
Don't Know
Other (please specify)

10.Describe the reason for your referral. Please be as specific as possible:*
Share |

Elmhurst College • 190 Prospect Avenue • Elmhurst, Illinois 60126-3296 • (630) 279-4100 or (630) 617-3500

 

Undergraduate Admission • (630) 617-3400 • (800) 697-1871 • admit@elmhurst.edu

School for Professional Studies • (630) 617-3300 • (800) 581-4723 • sps@elmhurst.edu

Elmhurst Learning and Success Academy Admission • (630) 617-3752 • elsa@elmhurst.edu

 

Technical Support