Student Name:
ID Number:
Date of Meeting:		"Meeting" can also refer to a phone conversation, email correspondence, etc--however you communicated your concerns to the student.
Your Name:
Your email/phone:

Meeting Outcome:

The student and I discussed some/all issues and we have created a plan.

I communicated my concerns to the student and he or she has created a plan.

I spoke with the student, but believe that he or she still needs assistance.  Please have someone on the Early Alert committee contact him or her. (If you can provide additional information about your contact, please include it below)

I have made an attempt to contact this student, but he or she does not respond.  Please have someone on the Early Alert committee contact him or her.

I have not contacted the student, and do not plan to do so. 

Additional notes: