SEAS Referral Form

The SEAS Referral Form is an integral part of the Student Early Alert System at UWEST. Use this form to alert the SEAS Team of any student facing academic difficulty, not making satisfactory progress, or exhibiting behaviors that may lead to academic difficulty (e.g. non-attendance, lack of participation, inattention in class).

Simply complete the information below and submit by clicking on Send. Some of the more common issues are listed on the form, and space is provided to write in any issue not listed. Your detailed comments will assist the SEAS Team to assess the level of intervention that is appropriate and needed.

The form will be directed to the Success Center Coordinator and forwarded to the SEAS Team. This team will take appropriate action to improve the student's chance of success at UWEST. You may also download the form and deliver it to the Coordinator of the Student Success Center.

Thank you for taking the time to share your concern. Early and informed intervention is often critical to a student's success.

General Information

Faculty/Staff Name: *

Faculty/Staff Email: *

Student's Name as listed on roster: *

Other Name(s) used:

Student's ID Number:

Have you discussed the situation with the student?

      If yes, what was the result of the conversation? If not, what was the reason?

Is this concern related to a specific course?

Areas of Concern

Please select the area(s) of concern and provide details on the selected item(s) in the box below:

Class attendance

Classroom behavior

English Language Proficiency

Incomplete/missing assignments

Low test/quiz scores

Personal issues affecting student

Poor/underdeveloped study skills or time management



Please provide more detail on the selected item(s) in the space provided: