Faculty Referral Response

Faculty Referral Response

This form will be used by the student support staff to follow up with faculty regarding a requested intervention.

Your Name*

First Name

Last Name

Position/Relationship to Student

Academic Skills Enhancement Specialist Faculty Advisor Athletic Coach Class Dean Academic Success Center Support Staff

Other:

Athletic Coach

Yes No

Your Email*

Your Phone

Instructor Name*

First Name

Last Name

Instructor Email*

Course*

Student Name*

First Name

Last Name

Student M ID#*

Student Athlete

Yes No (Also choose if the request showed "unsure")

Sport

Baseball Basketball Cross Country Football Golf Tennis Track and Field

Which option best describes the situation reported?*

Failure to Attend (student did not attend class or make contact before the add/drop period ended) Attendance Policy Infraction (student has exceeded number of allowed absences) Poor Performance (student does not have the assumed knowledge needed to excel in this course) Poor Performance (concern regarding student commitment/efforts) Behavioral Concern (beyond normal classroom management issues) Exemplifying Learning Traits that Signal Disability Services May Be Needed.

Other:

Follow Up *

I have followed up with the appropriate Morehouse staff for resolution No follow up required

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