CONTINUOUS REPORTING SYSTEM

Contents of this form should be handled confidentially

Date:


I am concerned about:

Student Name:


Student ID#, if known:


Year:


Course/Section:


Current estimated grade/ general grade level of work thus far:


Instructor:


I have discussed the problem with the student: Yes     No
The student knows that I am sending this CRS form: Yes     No
I have recommended a student tutor through the Academic Support Center: Yes     No

I recommend this student be seen by the appropriate dean
FYI only: please take no action at this time. I am working with student.

REASON FOR CONCERN (check all that apply):
Missed quiz/exam Does not participate/appears distracted in class
Failure to turn in assignments Suffers/seems to suffer from personal difficulties
Irregular/lack of attendance Failure to respond to my notes/voice messages/e-mails
Level of work seems too difficult Other


Comments (Note: CRS form is available for student's review upon request)