Early Notification Form

Middletown

Meriden

Fully Online

AREAS OF CONCERN FOR THIS STUDENT (Check all that apply):

1. Missed quiz(zes)/exam(s)/papers

2. Irregular/lack of attendance/chronic lateness

3. Poor performance on quiz(zes)/exam(s)

4. Failure to respond to my notes/voicemail messages/email

5. Failure to adhere to classroom expectations

6. Failure to turn in assignments

7. Failure to participate/appears distracted in class

8. Poor performance on assignments

9. Comes to class unprepared

10. Other (describe below):

(i.e. inappropriate use of electronic devices, disruptive behavior, etc.)

RECOMMENDED ACTION FOR THIS STUDENT (Check all that apply):

1) Schedule a meeting with instructor (location: )

2) Take advantage of the Career Development & Counseling Center Services (Founders Hall, Room 121)

3) Take advantage of Disability Support Services (Founders Hall, Room 121)

4) Take advantage of the College Learning Center for tutoring services (Chapman Hall, Rm.711/Meriden Center, Rm. 403)

5) Take advantage of Library services (Chapman Hall)

6) Take advantage of Financial Aid Office services (Founders Hall, Room 132)

7) Meet with Student Retention Specialist (Meriden Center, Room 401)

8) Other (please describe):

For subject specific study guides, visit theCollege Learning Center website.

ADDITIONAL INFORMATION FOR FOLLOW-UP OFFICE (Check all that apply; add comments as necessary):

I have given a copy of this to the student.

I have not been able to contact the student.

I have previously taken the following action:

I am unable to contact the student and request that someone else attempt to reach him/her.

Comments: