Ivy Tech Community College of Indiana

Ivy Tech Community College Academic Evaluation & Referral

Please help Ivy Tech assist your academic progress here at Ivy Tech Community College. The information you provide will help us advise you and intervene before you become academically at risk. If you are struggling, we are here to help. Please complete and submit this form. This will be sent to Jeannette Harris ( jharris@ivytech.edu).

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.

Course Information:

Your Name		(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)
Do you feel you are making adequate progress?		Yes No
If no, what do you perceive is hindering your success?		Attendance Academics Other If other, please specify
What do you think might help?		Complete Missing Assignments Seek Tutorial Assistance Attend Study Skills Workshops Complete A Life Skills Course (IVY) Consider Course Withdrawal
Comments or more detailed explanations (recommended)

Additional Information:

Instructor's E-mail		(e.g. jdoe@ivytech.edu)
Today is

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

Changing Lives

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