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Student Success Center - Early Alert Referral Service
EARS Referral Form
General Information (Please fill in all fields.)
Referred by
Your telephone number
Student name
Wildcat username
W number
Student Contact Info
Telephone number
Cellphone number
Campus email address
Comments on contact info
Reasons for Referral
Academic Issues
Grades
Attendance
Homework
Other (please explain below)
Physical/Mental Health Issues
Illness
Needs encouragement
Personal issues
Other (please explain below)
Major/Career Issues
Undecided major
Unsuitable major
Other (please explain below)
Other Issues
Crisis at home
Financial
Other (please explain below)
Explain the situation and suggest how we can help
