Early Alert Form

We appreciate your support of students in filling out an early alert form. This form will be routed to a member of the Student Success team to follow up with the student. Please share as much information as possible to help us as quickly and efficiently as possible. Please note, this is not an emergency reporting form -If this is an emergency or an individual is in danger, please contact Capital University Police at 614-236-6666.

If you are reporting information related to Title IX, please use this reporting form instead.

I am a Capital University Slate User.

Yes

Unsure

SLATE Users: Log in before searching for student name/ID number.

Search for Student by Name or Colleague ID
Be sure to select the student from the dropdown list

Please use text fields to enter student information below.

Student First Name

Student Last Name

Student Colleague ID

Nature of Concern

Please select the category (or categories) of your alert.
(You will have the option to select more specific information under each category.)

Please select any Accommodations subcategories.

In the Classroom

Other (dining, housing, etc.)

Please select any Basic Needs subcategories.

Food Insecurity

Has Other Basic Needs That Need Monetary Support

Housing Insecurity

Please select any Family Related subcategories.

Conflict within Family

Death in Family

Illness in Family

Job Loss in Family

Please select any Financial subcategories.

Financial Aid is Not Enough

Has Other Basic Needs That Need Monetary Support

Needs to Support in Purchasing Course Materials

Working Too Many Hours

Working Too Many Hours to be Successful

Please select any Personal subcategories.

Please select any Sense of Belonging subcategories.

Homesickness

No Connections on Campus

Not Making Friends

Please share any reasons the student shared as to why they are thinking of leaving Capital:

What action, if any, have you already taken on this alert?

Please share any additional information about this alert.

Submitter Information

Submitter First Name

Submitter Last Name

Submitter Email Address