FSCJ Early Alert Form

FSCJ Early Alert and CARE Report

Please note that this form is not to be used for concerns that require immediate medical or emergency response. If you need to report an urgent issue that requires immediate attention, please alert your campus security office or call 911.

Reporter TypeRequired *

Faculty TypeRequired *

Your DepartmentRequired *

Other (please specify)Required *

Reporter's NameRequired *

Please type your First and Last Name

Your FSCJ EmailRequired *

Your Phone Number

Student of ConcernRequired *

Please list the name, Student ID, and email (if possible) of the student named in this report. One report per Student.

Student of concern (name and ID number)

One student for each Early Alert Report

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Are your concerns related to a specific course?

Are your concerns related to a specific course? Yes Are your concerns related to a specific course? No

Course Information

Please provide course ID/title

Campus/Center LocationRequired *

Did the student miss a scheduled make-up test?Required *

Did the student miss a scheduled make-up test? Yes Did the student miss a scheduled make-up test? No

Have you notified the instructor?

Have you notified the instructor? Yes Have you notified the instructor? No

Student Reporter

Report is about another student
Report is about myself

Does student have dependent children in the home?Required *

Descriptive Information

Report Type(s)Required *

Academic Concern

Concerns related to a student's academic progress or challenges a student may be facing in the classroom.

Change in Academic Performance

Marked difference(s0 noted in class participation/class discussions and/or graded assignments/tests.

Difficulty Understanding Coursework

Concern relates to student not understanding written or oral descriptions of assignments or course content.

Frequent Absences/Tardies

Concerns related to attendance and/or coming to class late.

Frequently Leaves Class Early

Concerns relate to leaving class early and missing critical class discussion.

Lack of Engagement in the Classroom

Concern relates to student not putting forth their best effort in the classroom.

Poor Performance on Assignments

Concern relates to student who is earning a grade of below 70% on assignments/tests.

Lack of technology/technology issues

Student has been unable to acquire the required technology, or is having troubles navigating the technology.

Medical Concern

Medical issues that may be interfering with student's ability to attend class or to be successful in an academic setting. This could include alcohol and drug abuse, learning or other disability, chronic health conditions, eating disorders, etc.

Mental Health Issue

Mental health issues may include anxiety, depression, suicidal thoughts or intent, symptoms that might be consistent with a mental illness, etc.

Navigating College Systems

Student is experiencing challenges understanding how to navigate college policies or processes in order to resolve a particular issue and needs assistance to resolve the issue.

Non-Academic/Life Situation

Concerns related to external situations such as child care, food insecurity, homelessness, family issues, etc.

Physical/Psychological Endangerment

Concerns related to possible victimization of a student or risk potentially being inflicted by a student. Might include things such as hazing, bullying, interpersonal violence, dating/domestic violence, sexual misconduct, sexual assault, or other emotional/physical abuse.

Social/Adjustment Concern

Student is experiencing adjustment problems. This may be due to a variety of factors such as lack of preparation, undecided major, poor social skills, poor decision making skills, identity development issues, lack of support network, etc.

College Policy/Process or Professor/Department Complaint

Student has a concern about an FSCJ policy, process, access to courses, or appeals.

DescriptionRequired *

Please use the space below to provide additional clarification that will help us provide appropriate outreach and intervention.

Student Information

Have you approached the student regarding your concerns?Required *

Have you approached the student regarding your concerns? Yes Have you approached the student regarding your concerns? No

Steps you have taken to discuss your concerns with the student. Check all that applyRequired *

Written Communication (note or letter)
Email
Individual Conversation
Phone Call
Other

Additional Comments

Please provide any additional comments that may help us as we determine a course of action.