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Early Alert Response System - Team Response Documentation
This form is to be submitted by all support services staff who have received a request from the EARS response team to monitor or directly aid a student. Use checkboxes and information fields to update the response team regarding the progress and initiative of the identified student. Please respond within two weeks of referral so information can be used at the next team meeting.

::::::: INDIVIDUAL YOU ARE MONITORING AND/OR HELPING

Student's Nametrue
Student's ID Number (if applicable)students_id_number_if_applicable
Course Name (if applicable)course_name_if_applicable
EARS Team Decisiontrue

::::::: SECTIONS 2 & 3

Check box that applies, then document who should be involved (and how) in SUPPORT STAFF INVOLVEMENT field below
Section 2 - Initial Decisionprogress
Section 3 - Assessment of Progresssection_3___assessment_of_progress
Describe Additional Incidents - provide specific detailsdescribe_additional_incidents
0 /
Support Staff Involvement - Explain actions recommended or taken, to whom student was referred, and results. Document other behaviors, observations, progress, or concerns as necessary.support_staff_involvement
0 /

::::::: MY PERSONAL INFORMATION

Nametrue
Phone Number/Extensiontrue
Department/Divisiontrue
Job Titletrue

::::::: NOTICE

EVIDENCE TO SUGGEST FALSE OR MISLEADING REPORTS WITH INTENT TO DEFAME THE CHARACTER OF ANOTHER, MAY RESULT IN DISCIPLINARY ACTIONS.
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