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Early Alert Referral Form - 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.

Asterisk (*) indicates a required field.

Student Information
(Include area code.)
Instructor Information
(Include area code.)
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):

  • - Please specify the student's ability/preparedness issue(s):
  • -

A counselor will contact you if more information is needed.

Your privacy is important to us. Your personal information will not be sold or shared with unaffiliated third parties except as necessary to maintain and process client accounts or when the law requires it.

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