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NC Early Warning Referral System

Date of Notice    
Student ID Number Student Email
Last Name First Name
MIddle Initial    
Course Name Dept. & Course #
Section Instructor
Instructor Email    
Current Problem(s) check all appropriate fields
Discipline Lack of interest
Excessive Absences* Low Test Grades*
Excessive Tardiness*/Leaving Early* Low Daily Grades*
Potential of Removal from ALL NC Courses Nonattendance for Two weeks*
  Other
If Other, please specify

Comments

*Please see the catalog and your syllabus regarding the importance of regular class attendance, developmental education, and the minimum standard of work (grade point average requirements)

Deadline for Student to contact instructor



Enter the characters you see above (case sensitive)

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