Refer a Student to Thrive

Only use this form if you do not have access to the Early Alert system in CNC Connect.

Submitter Information

I am

Administrator
Faculty
Operational Staff
Students' Union Representative
Campus Housing Advisor

First Name*

Last Name*

Email*

Department*

Job Title*

Course Code & Section Number

if applicable

First time teaching this student

Yes
No
N/A

First time referring a student

Yes
No

Student Information

Student First Name*

Student Last Name*

Student Number*

Preferred Phone Number

Preferred Email

Did you discuss the Early Alert & Thrive program with this student?
Please note you are strongly encouraged to discuss your referral with the student before submitting this form if possible.

Yes
No

Select from the following areas you have observed student struggling with.

Select all that apply.

Academic Concerns

Course Load, Content and Equipment

Appears to be struggling with heavy course load
Could benefit from reduced course load
Does not have the equipment or textbooks needed for their class(es)

Academic skills and processes

Appears unprepared
Appears to have underdeveloped study skills
Appears to have underdeveloped writing skills
Has shown decline in quality of work and grades
Has made multiple requests for extensions
Is falling behind
Has missed more than one assignment
Appears to have/reports difficulty working in groups
Academic misconduct corrective measures and/or sanctions have been applied, as per the Academic Conduct Policy
Reports they have been notified they are on Academic Alert or Probation and seem unsure how to handle this
May need information about and/or support around a Grade Appeal

Attendance

Is regularly absent or late to class

Personal Resilience/Well-being Concerns

Adapting to post-secondary transition

Could benefit from better understanding of academic expectations
Appears overwhelmed by the college experience and academic demands
Shows signs of underdeveloped college/career direction and purpose
Reports they may require academic accommodations due to a medical condition but have not connected with Accessibility Services

Personal resilience skills and well-being

Appears to (or reports) struggle with time management
Appears to (or reports) struggle with stress management or self-care
Has disclosed incidents of racism and/ or discrimination (e.g. microaggressions)
Has disclosed feeling othered in the campus community
Has disclosed personal problems (e.g., family conflict, relationship issues)
Has suddenly changed appearance
Has suddenly changed attitude
Has disclosed they are experiencing culture shock
Has disclosed having difficulty transitioning to a new environment

Basic needs

Has disclosed or shows evidence of food or housing insecurity
Has disclosed financial challenges

Mental Health & Medical Concerns

Emotional distress and mental health concerns

Appears anxious or overwhelmed
Cries or appears tearful
Appears to be distressed, disoriented, or disengaged
Reports they are experiencing depression, anxiety, grief and loss, or other emotional difficulties or mental health concerns
Has disclosed problems with substance use
Has disclosed/you have observed they were involved in a traumatic incident and they potentially require de-briefing and/or support
Reports being impacted by intergenerational trauma
Has disclosed hearing voices or seeing things that other people cannot see
Has disclosed having suicidal thoughts
Has disclosed that they have self-harmed

Medical concerns

Has disclosed they are experiencing a health issue
You have observed changes in their physical health (e.g., noticing ongoing coughing, nosebleeds, visible injuries, etc.)
Has disclosed they don’t currently have access to a family doctor and need medical support
Reports or appears to be experiencing memory problems, slurred speech, drowsiness, confusion, or lack of coordination

Non-Academic Misconduct/Safety Concerns

Teaching/learning environment

Disrupts the ability of others to learn, or the ability of the instructor to teach
Brings unfounded complaints with malicious or frivolous intent
Displays emotional responses that appear disproportionate to the situation
Makes excessive or unreasonable demands for attention or special treatment from faculty/staff.

Safety

Engages in conduct that threatens or endangers the health, safety, well-being of any person
Creates a condition that endangers or threatens destruction of College property or property that is not their own
Was observed or reported engaging in sexual misconduct

Interpersonal Concerns

Engages in acts that appear to be motivated by hatred or discrimination
Uses electronic devices, online communication, or social media to engage in negative or harmful interpersonal interactions
Engages in verbal abuse, intimidation or harassment

Other concerns or more detailed comments

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Areas of Study

Campuses

Services at Prince George Campus

Services at Burns Lake Campus

Services at Fort St. James Campus

Services at Mackenzie Campus

Services at Quesnel Campus

Services at Vanderhoof Campus

Prince George

Burns Lake

Fort St. James

Mackenzie

Quesnel

Vanderhoof

Governance

Initiatives & Reports

Refer a Student to Thrive

Submitter Information

Student Information

Select from the following areas you have observed student struggling with.

Academic Concerns

Personal Resilience/Well-being Concerns

Mental Health & Medical Concerns

Non-Academic Misconduct/Safety Concerns

Prince George Campus

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