EARLY ALERT STUDENT REFERRAL FORM - Northland ...

(For Retention Group Use Only)Letter sent: ____________________Faculty/Staff contacted: __________ADVISOR/COUNSELOR:________________________________________________RESULTS:( ) Meeting completed ( ) Date: ________( ) Requires more meetings( ) Referral( ) Plan decided upon and/or comments( ) Other_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Retention Group Member’s Signature_________________DateNorthland Community and Technical College is a proud member of the Minnesota State Colleges and Universities system and is an Equal Opportunity employer and educator.