Early Alert

If you are concerned about a student’s academics or personal well-being, please fill out as much information as possible in this form. Your submission will be triaged by Student Affairs and shared with the appropriate area for follow-up. Services include, but are not limited to, Counselling Services, Academic Advising, Accessibility Services, Financial Aid and Awards, and the Conduct and Care Office.

If this is an emergency do not use this form but call 911 or Campus Security at 250.740.6600 and/or consult with the Vancouver Island Crisis Line at 1-888-494-3888.

Please see the following website for more information and resources to support students in distress.

Student Information

First Name *

Last Name *

Student Number (if known)

Program the student is in (if known)

Email address (if known)

Phone number (if known)

Other contact information (if known)

Concern

Area of concern *

Brief Overview of Concern *

Have you spoken to the student about your concerns?

Can we let the student know that you forwarded this concern when we reach out to them?

Additional Student Information (please check all that apply)

International Student

Indigenous Student

Residence Student

Dual Credit Student

Other campus

Your Contact Information

First Name *

Last Name *

Email Address *

Student Number (if you are a student)

Department Name (if you are staff or faculty)

Phone number

Other contact information

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