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The Early Alert System is a service at Penn State New Kensington that provides employees an opportunity to share a concern about a student's academic progress, wellness or safety. The main purpose is to identify and intervene earlier with students who appear to be having academic or psychological difficulties although other situations of crisis or concern are also welcome.


If this is an emergency dial 911.


Date:
Name of Person Reporting:
Status:
Faculty
Staff
Administrator
Department/Division:
Phone:
Cell Phone:
Email:

Student Name:
Phone:
Cell Phone:
Email:
Address:


Perceived Issues/Concerns:
Academic

Health

Safety

Identified Behaviors Causing Concern:


Identified Verbal/Written Concerning Statements:


Actions Taken To Date:
Check All That Apply.
None

Shared observations and concerns with student

Provided campus/community resources to student

Referred student to

Referred Student to the following resources:

Counseling

Health Services

Disability Services

Student Success Center

Financial Aid

Advisor

Career Services

Student Affairs

Other:

Informed student that I would notify the early alert system.

If student was referred to resources, how was the initial referral made?
Check all that apply.
Face to face meeting with student

Through email

By phone

Informational Handout on the referral service given directly to student

Phone call to referred department with student present

Other

Date Referral was Made:


Thank you for sharing your concern with us. The name of the person reporting this information will not be shared with the student. Receipt of notification will be provided.