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Student of Concern Notification
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* Indicates required question
Student First and Last Name:
*
Your answer
Student UA ID Number:
*
Your answer
Instructor First and Last Name:
*
Your answer
Instructor Email:
*
Your answer
Semester:
*
Your answer
Course Number:
*
Your answer
Subject:
*
Your answer
Section Number
*
Your answer
I have made contact with the student:
Yes
No
Clear selection
Reason(s) for Referral:
(may select more than one)
Poor Attendance
Frequently Late
Poor Attitude/Behavior
Poor Class Participation
Not Prepared for Class
Failed Exams or Quizzes
Failure to Complete Assignments
Remedial Attention Needed
Other:
Other Comments of Reason for Concern:
Your answer
Action(s) Taken by Faculty:
(may select more than one)
Discussed problems in person
Talked to student on the phone
Contacted student by email
Discussed absenteeism
Discussed student academic progress
Referred student to Student Services
Referred student to Learning Center
Referred students to Computer Lab
Suggested student withdraw from course
Other:
Other Actions Taken by Faculty:
Your answer
Suggestions to help the student in class:
(may select more than one)
Attend class regularly
Participate in class
Find a study partnergroup
Complete and hand in assignments on time
Improve the quality of homework turned in
Take notes in class and review them daily
Assess time management and/or study skills
Come to class prepared
Not applicable
Other:
Other Recommended Actions:
(may select more than one)
Seek academic advising
Withdraw from course
Provide documentation for course placement
Re-evaluate academic goals
Consider course load reduction
Not applicable
Other:
Recommended Services
(select all that apply)
The Learning Center or Online Tutoring
Financial Aid Assistance
Computer Lab or Technical Support
Student Coaching
Academic Advising
Not applicable
Other:
Other Recommended Services:
Your answer
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