Exit Online Form 

Student Early Alert System Form

Thank you for identifying a need to assist and support one of our students.  This Early Alert form has been provided to faculty members as a mechanism to help students.  General Education Development Center (GEDC) will forward all sophomore, junior, and senior student notifications from faculty to The Counseling and Wellness Office for student intervention. If the faculty member feels that a student is in a compromising or emergent situation, please contact the Paine College Office of Security at 706-821-8235.

Please complete ALL student contact information before referring.

Student Information






Faculty Member Information







Observed Issues

Please identify issues that you have observed with students in the categories below.  Check one or all that apply:



















Please answer the following questions and be as detailed as possible.






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