Retention Alert Form

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Instructor Name*

Instructor IVCC Email Address*

Course Number, Subject, and Section*

Student ID Number*

Student Last Name*

Student First Name*

Reason for the Retention Alert*

Not attending an in-person class.

Not logged in to an online class.

Not actively participating in an online class.

Struggling with using technology.

Test score(s) is/are low.

Course grade/average is low.

The student may need support for food resources.

The student may need support for housing/shelter resources.

The student may need support for transportation to class.

The student may need financial support to stay in college.

Have you attempted to contact the student?*

Yes

No

If you attempted to contact the student, please describe how (email, phone).

Suggested Follow Up*

Contact from an academic counselor (schedule, workload, etc.)

Contact from a success coach (organization, time management, study skills)

Contact from a personal counselor (personal needs, health concerns)

Contact from the Center for Accessibility and Neurodiversity office

Contact from a subject matter tutor

Contact from a librarian; research, source support

Contact from a help desk staff; technology support

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