College Achievement Program:
Confidential Student Assessment and Early Warning

Please select or provide response's or information only for those individual items that you believe needs to be addressed, or that apply to, the particular student for whom you are submitting this evaluation. Be Sure to include any specific or general recommendations or comments you may have (See Item #18 ). Please enter the correct course and section number and code. Click on "Submit" when you have finished.

Thank you for your assistance!

Question 1: Course and Section Number:

 

Question 2: Instructor's Name, Email, and Validity Code:
Name:

Email:

Validity Code:

Question 3: Student's Name:

 

Question 4: Instructor's Follow Up Action:
 Have not contacted student as yet. Only providing assessment.
Providing assessment resulting from or after contacting student.
Have contacted student. Providing assessment for additional follow-up by advisor.

 

Question 5: Attendance:
 No Show (Student has not appeared in class.)
Quit Attending
Excessive Absences
On-line Course: Student has not responded to instructor's initial contact or instructions.

 

Question 6: If the student has "Quit Attending", what was the last date attended?

 

Question 7: If the student has "excessive absences", please answer the following:
A. The number of class sessions thus far:
and, B. The number of absences:

 

Question 8: Number of missed assignments:
1 to 2
3 to 4
5 to 6
7 or more

Question 9: Number of assignments thus far:

Question 10: Number of Missed Deadlines or Due Dates?
1 to 2
3 to 4
5 to 6
7 or more

 

Question 11: Number of deadlines or due dates thus far (approximate or specific):

 

Question 12: Performance on Assignments:
Excellent
Good
Fair
Barely passing
Less than acceptable/failing
Very Poor

 

Question 13: Exam grades -- List each exam separately. State your evaluation of each one ONLY as "Excellent", "Good", "Passed", "Failed", or "Very Poor".

 

Question 14: Tutoring Needed
Math
English
Accounting
Economics
Study Skills
Exam Preparation/Completion
Other (Go to question #14)

 

Question 15: Describe other tutoring or assistance needed:

 

Question 16: Participation, Cooperation, Attentiveness"
Seldom or never participates in course discussions or activities.
Uncooperative with instructor and/or with group activities.
Often inattentive.
Disrespectful of instructor, other students, or disruptive of the learning situation.

 

Question 17: If this student is experiencing or displaying any other behavioral or emotional difficulties that, in your opinion, interferes with his/her performance or that you believe warrants intervention, please so indicate. Be specific if possible.

 

Question 18: Your Recommendations or Additional Comments: