Department of Academic Assessment

Academic Alert Form

The Faculty Handbook for the Academic Alert Program can be viewed here.

Disclaimer: If you have an immediate concern about the student's safety,
please contact the USM Police Department at 780-5211.

Date: CRN:

Mode of Instruction: Regular (live) Classroom Online Course ITV Course

Location of Course: Portland Gorham Lewiston Remote Site

Course # (e.g. ENG 100):

Course Name (e.g. College Writing):

Instructor: Instructor Email:

Please write the student name and check the appropriate areas of concern.

Student Name	Low Grade	Performance	Attendance	Financial	Behavioral/ Emotional	Other	Already contacted or met with student	Planning to meet with student	Prefer to have Advisor meet with student	Comments

Other Recommendations/Comments:

Please indicate your office hours:

As a result of submitting this form:

1. Students will be contacted by the Student Success Center. The student's academic advisor will receive documentation of that contact.

2. Anything submitted will be documented and put in the Advising file.

You may wish to print this form prior to submission to retain a copy for yourself.

By submitting this form, you may be contacted for more information.

To contact Academic Assessment about the use of this form, please email Susan King or call 780-4681.