TEAMS Outreach Center: Student Self-Alert Form

1. How can we help you? *This question is required.

• I want to ask a question. (I have a question about locating information or getting connected with the right person at the college.)
• I want to submit a self-alert. (I have a personal hardship, academic concern, or attendance issue that is affecting my classes.)

8. Check all that apply. *This question is required.

• I am enrolled in a Health program.
• I am a high school student taking college classes.
• I am a GED student taking college classes.
• I am a GED student.
• I am a military affiliated student. (I, my spouse, or my parent is serving in the military or has served in the military.)
• None of the above.

9. Is the concern related to a specific class or classes?
Note: You must complete a new form for each class. *This question is required.

• Yes
• No

9. Do you need to submit an alert for another class?  *This question is required.

• Yes
• No

9. Do you need to submit an alert for another class?  *This question is required.

• Yes
• No

9. Do you need to submit an alert for another class?  *This question is required.

• Yes
• No

9. Do you need to submit an alert for another class?  *This question is required.

• Yes
• No