E.A.R.S FORM
STUDENT FIRST NAME:
STUDENT LAST NAME:
DATE:
REFERRED BY:
CLASS:
OFFICE PHONE:
EMAIL:
PLEASE CHECK ALL THAT APPLY*:
Academic Performance
Attendance
College Major/Career Choice
Personal
Financial Problems
Other
ADDITIONAL COMMENTS:
*At-risk behaviors may include: excessive number of absences or tardies; test failure; incomplete assignments; lack of class involvement; suspected substance use or “hang-overs”; expression of personal problems; depression/apathy; study skills deficiency; comments about dropping out; problems with instructor.
For Questions Contact:
Suzanne Hunger, E.A.R.S. Director of Student Success, Donaldson Building, 447-
6938