Division of Academic Enhancement at The University of Georgia

Early Alert Electronic Referral Form

For UGA Faculty and Staff Use Only

By providing us with the following information, we can follow up with the student and connect them with appropriate campus resources that meet his or her specific needs. Please remember that the Early Alert program handles concerns of an academic nature. If you have concerns about a student’s mental or emotional health, please refer them to Counseling and Psychological Services. Students have legal access to the information you provide, so please state your concerns in an objective manner.

Student's name:
Student's e-mail:
Course (if applicable):
Faculty or Staff member's name:
Faculty or Staff member's e-mail:
Faculty or Staff member's department:
Please indicate the areas in which you believe the student is in need of academic support. Check all that apply.	Course content Reading strategies Note-taking skills Time management skills Test preparation or test-taking strategies Test anxiety or general academic anxiety Motivation Writing skills assistance Class attendance Career or major exploration Learning style assessment Personal issues Other. Please explain below
Additional comments