Ivy Tech Community College of Indiana

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Ivy Tech Community College Academic Evaluation & Referral

Please help Student Affairs monitor the academic progress of Ivy Tech Community College students. The information you provide will help us advise students and intervene, if necessary, when a student is academically at risk. Please complete and submit this form. This will be sent to Jeannette Harris ( jharris@ivytech.edu).

Instructors of all skills advancement courses are required to complete this form.
All instructors are encouraged to use this form to report academic concerns of students.
Ideally, this form should be completed by the end of the 6th week of a 16 week course or by the end of the 4th week of class for an 8 week class, however, it may be completed any time during the semester when you wish to make student affairs aware of student academic concerns.

Course Information:

Student		(e.g. John Doe)
Course & Section		(e.g. ACC 101 11I)
Term		[ help ]

Evaluation:

What is the most recent date of attendance?		(e.g. mm/dd/yy)
Is the student making adequate progress?		Yes No
If no, what do you perceive is hindering the student’s success?		Attendance Academics Other If other, please specify
Suggested action plan		Complete Missing Assignments Seek Tutorial Assistance Attend Study Skills Workshops Complete A Life Skills Course (IVY) Consider Course Withdrawal
Summary of advisory session (recommended)

Additional Information:

Your E-mail		(e.g. jdoe@ivytech.edu)
Today is

Form created by Form Forge. Contact jharris@ivytech.edu for assistance.

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