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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
Non-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
 
    


Weber State University, Student Success Center
Ogden, Utah 84408-1132
studentsuccess@weber.edu, (801) 626-6752 (option 5)