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I have received several requests for the academic probation questionnaire and
contract that students complete with me when we initially meet.  Many of the
questions on the questionnaire come from The Confident Student, 2nd edition, by
Carol C. Kanar.

Since my computer sends attachments in MIMI format, I have attempted a cut and
paste maneuver here (we warn you not to try this at home).  This move threw out
the original tab settings, so please use your imagination when reading the
documents, and then print, retype and use (or not) as you see fit.

Please let me know if you have suggestions.  I'm definitely still fine-tuning
the process that I go through with students on academic probation.

Lisa Kramme

ACADEMIC PROBATION QUESTIONNAIRE
DATE:
1. NAME:
2.   GRADE LEVEL:
3.   MAJOR:
4.   PHONE:
5.   ADVISOR:
6.   ADDRESS:
7.    REASON FOR ACADEMIC PROBATION:
8.  CURRENT SEMESTER CLASSES (COURSE INSTRUCTOR DAYS---TIMES)







9.    WHAT IS YOUR CAREER GOAL(S)?



10.  CIRCLE YES OR NO FOR THE FOLLOWING QUESTIONS:
A.  I usually have a goal I am trying to reach.  YES NO
B.  When I am listening to a lecture, I do not become distracted.     YES NO
C.  I know the words to listen for in a lecture that will tell me what is
important.   YES NO
D.  I usually take notes during class.   YES  NO
E.  When I take notes, I am able to keep up with the lecturer.     YES NO
F.  I know how to manage my time.   YES  NO
G.  I almost always arrive on time for classes.  YES NO
H.  Only sickness or emergency prevents me from coming to class.    YES NO
I.  When I have a lot of studying to do, I have no trouble getting started.
YES NO
J.  I can usually remember what I ve studied well enough to get good grades on
tests.   YES  NO
K.  I associate new material to be learned with what I already know.     YES NO
L.  I have a certain place where I do most of my studying.      YES NO
M.  I am not easily distracted when there is something I need to study.    YES
NO
N.  I do not hesitate to ask questions in class.  YES NO
O.  I use a study technique such as SQ3R.  YES NO
P.  I usually know what to study for tests.  YES NO
Q.  I am almost always prepared for tests.  YES NO
R.  Taking a test does not make me nervous.  YES NO
S.  If I don t know the answer to a multiple-choice question, I use guessing
strategies.   YES NO
T.  I know what my learning style or preference is. YES NO
U.  On a scale of 1 to 10, I would rate my research papers:
     1(poor)  2         3          4          5          6          7
8         9         10(great!)

STUDENT SUCCESS CONTRACT

I, ___________________, agree to the following in order to assist my academic
performance and success.

1.  Utilize TLC services for at least _____ hours every week.
Week 1:  Week 2:  Week 3:  Week 4:  Week 5:  Week 6:

Week 7:  Week 8:  Week 9:  Week 10:  Week 11:  Week 12:

Week 13:  Week 14:

2.


completed on (date)___________
3.


completed on (date)___________
4.


completed on (date)___________
5.


completed on (date)___________
6.


completed on (date)___________
7.


completed on (date)___________
8.


completed on (date)___________
9.


completed on (date)___________
10.   To avoid academic suspension I will achieve a minimum GPA of _______
(term   cum).--circle one.

STUDENT SIGNATURE:_____________________

DIRECTOR OF ACADEMIC SUPPORT SERVICES SIGNATURE:___________

DATE:____________________

Was the student given a copy of this contract? YES NO