Difficulty with responsibilities in Class Attendance
Directions: Please select all that apply to the student.

Student is constantly tardy.
Student constantly absent without contacting instructor.
Student has excessive absences.

Difficulty with study habits and assignments
Directions: Please select all that apply to the student.

Student did not pass the first test
Student did not pass in the first assignment
Student does not take notes
Student does not hand in regular assignments
Student has difficulty understanding assignments
Student has low grades
Student lacks participation in class
Student does not read text
Student does not organize assignments
Student does not take lecture notes

Other

Difficulty with responsibilities in Class Attendance
Directions: Please select all that apply to the student.

Student has never logged in to course.
Student logs in sporadically.
Student logs in on a regular basis.

Difficulty with study habits and assignments
Directions: Please select all that apply to the student.

Student did not pass the first test
Student did not turn in the first assignment
Student does not submit assignments on time
Student sporadically submits assignments
Student has difficulty understanding assignments
Student has low grades
Student lacks participation in class
Student does not appear to be reading text

Other

Have you received documentation from the student?
Yes      No

Has the student followed the schedule of accommodations that were agreed to?
Yes      No