Academic Alert Form

Instructions for Academic Alert Form

If you have academic concerns regarding your student(s) and wish to have University personnel follow up with the student, complete the Academic Alert Form. To report multiple students on one report, please enter student names and ID's in the "Description of the Concern" section on the form.

Please note: Instructors should always attempt to contact the student to resolve the situation first before sending an Academic Alert concern.

Your Name:

Your Role (Instructor, Advisor, etc.):

Your University of Dubuque Email:

Course Title, Number, and Section:

Student Name:

Student ID#:

Area of Concern (check all that apply): Attendance
Academic Performance
Classroom Incivility
Other (Please Specify)

Other:

For non-academic incidents/concerns involving students please report using Student Life Incident report in Maxient.

Description of the Concern: Please be as specific as possible so we can best help the student. For example, if a student is not attending, give a last date of attendance; if attendance is sporadic, provide the total number of absences. If citing a specific instance, include a date. (Pull lines in lower right corner to expand text area)