subject_line
Background Information
Date of Report
*
+
Course Number
*
Instructor Last Name
*
Campus/Center
*
Highland
Atchison/Tech
Western/Baileyville
Wamego
Online
Concurrent
Student Information
Student Name
*
Student ID
*
More Information
Reason(s) for concern:
*
Missed more than 2 consecutive classes
Failed test
Missing assignments
Unprepared for class
Lack of attention/non-participation
Poor behavior
Failed assignments/projects
Missed study groups
Multiple no-shows for appointments
More information regarding student:
Supplemental Documentation (photos, video, email, and other supporting documentation)