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Early Alert Referral - Counseling Department

Early Alert is a program designed to help students be successful at Ohlone College. A counselor will follow up with every student referred.

Instructions for Faculty: Please complete this form knowing the information you provide may be shared with the student.

All fields are required.

Student Information :

Last Name:
First Name:
Student ID Number:
Telephone:
Email Address:

Instructor Information:

Name (first and last):
Telephone:
Email Address:
Department/Course:

Probable Cause(s) of Student's Academic Problems:

Student is encountering academic problems due to one or more of the following (check all that apply):

Ability/Preparedness - please specify the student's
      ability/preparedness issue(s):
        Reading
        Writing
        Computation
Tardiness/Absences
Working/Class Conflict
Low Test Scores
Personal or Financial Problems
Motivation/Attitude
Language (non-native)
Other Description:

A counselor will contact you if more information is needed.