Academic Enhancement  

 

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Early Intervention - Faculty Referral Form

 

The Early Intervention is a referral source to help faculty members and others who are concerned about student’s progress throughout the semester, especially during the crucial weeks (4-6 weeks) prior to midterms.  To learn more, click here.

When you complete and send this form, the Office of Academic Enhancement will contact the identified student. An appointment will be made to assess the student's needs and to design a personalized plan to address the reported concern.

 

Today's Date

 

Name of Student                            
             

 

Student UIN

 

Student Contact Information (if known)

 

Course                                                 
                         

 

Referring Faculty

 

Contact Information for Referring Faculty

 

Reason for referral (check all that apply)

   Frequent or unexcused absences

   Tardiness/late to class

   Low quiz/test scores

   Poor quality assignments/homework

   Study skills

   Lack of preparedness

   Classroom behavior/attitude

   Other

 

Did you contact this student before completing this referral?

Yes     No

 

If yes, how did you contact the student?

 

If you chose "Other", please explain:

 

Additional Comments

 



   

 

Emergency Communications - E2 Campus Emergency Response Plan


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