Charleston Southern University

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Early Alert Form


Date	Required
E-Mail
Phone	Required
Professor Name	Required

Student Information
Name of Student	Required
SSN
Relationship to student
If instructor, course name and #	Required

What problem(s) have you observed?
Poor Academic Performance
Missing Class
Habitually Late
Frequently Unprepared
Financial Problems
Health or Personal Problems
Behavior Problems	(aggressive or withdrawn )

Other Problem

Tutoring
Personal Counseling
Career Counseling
Other action suggested

comments

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Charleston Southern University | 9200 University Boulevard, Charleston, SC 29406
Local Phone Number: (843) 863-7000 | Toll-Free Number: (800) 947-7474