Concern of Academic Performance Form


Dear SCA Faculty Member,

As a way to improve student performance and retention, the online submission form below is to alert the SCA Academic Advising Office and faculty advisor of a student in jeopardy of failing your course.

Please complete form after you have privately contacted the student and have not received a reply within 48 hours. The information provided below will be shared with the student's faculty advisor and the Academic Dean's Office.

Thank You,
scaadvising@sage.edu



INSTRUCTOR/COURSE INFORMATION

Date (MM/DD/YYYY)
Term
Year (YYYY)
Instructor Last Name
Instructor First Name
Instructor's MySage email
(____@sage.edu)
Course Section
(i.e., PSYC-101-10)
STUDENT INFORMATION  
  LAST Name
  FIRST Name
Student Date of Last Attendance
(MM/DD/YYYY)

Concern (select one)

Poor scores/grades to date

Attendance/participation concern

Struggles with course material, more effort needed

Missing/late assignments

Quality of work is unacceptable

Other or multiple concerns
        (please use comment box  below)

Withdraw from course recommended*
Yes
No
Other (please provide comments below)
Comments:
Please use the space below to provide additional information or other concerns.
(250 characters maximum).
*The undergraduate course withdrawal deadline is posted on the Academic Calendar.