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  • Failing Grades/Test
  • Fails to Complete Assignments
  • Excessive Absences
  • Failing Course Overall
  • Not Participating in the Classroom (in person or online)


  • Financial
  • Personal/Social
  • Planning to transfer
  • Disciplinary (major violation/alcohol)
  • Athletics
  • Doesn’t show for workstudy/job
  • Doesn’t show for appointments
  • Doesn’t respond to email or other communication


  • Attitude/Lack of Commitment
  • Adjustment Issues
  • Experiencing Grief
  • Changes in behavior or appearance
  • Disruptive behavior
  • Experiencing Distress

Other or Additional Comments:

  • Other

What are your recommendations for support?(Select all that apply):

  • Meet with staff member from the Office of Academic Success
  • Access resources/tutoring from the Writing Center
  • Access resources/tutoring from the Tutor Center
  • Meet with the Director of Counseling Services
  • Meet with staff from the Center for International Education
  • Have a Residence Life staff member check in with student
  • Encourage student to contact instructor(s)

Do you wish for your identity to remain confidential?

**Please note that we are unable to guarantee confidentiality in some situations

  • Yes
  • No
  • No Preference