STUDENT ADVISORY FORM Attendance / Academic Student's Name: DUMERAWO , eOWITCH Legler Date Program: Nursing oe Instructor: LHS OMA Course: _ BWATOMY _¢ PHYSIOLOGY Problem: (Check space or spaces applicable) O Disciplinary: Er header Min.GPA __3 Actual GPA. CO Attendance: No. of Tardy’s No. Absences: ‘Cannot complete program within max time O Other Description of Problem: (If more space is needed, use reverse side). Current course average is: 72.22% Minimum required to pass course is 75% Currently at risk of failing course. Cause: oor test performance Remedial Action: Student advised to review & change study habits as needed, including increasing study time, group work with others, and asking questions of instructor. Student aware that iis his her own responsibly to seek additional learning opportunities. Student is aware that instructor can always be reached via emal/after class with questions. Mandatory tutoring is required, Witnesses When Applicabl jive Action Taken: Ci Probation: date: From To C1 Dismissal (effective date) C. Reinstatement date Correc Ci Referral O Other Signature of Advisor: dt Time: Df —ate:_5/) 9/27 U ‘Student's Signature: Date: DON's Signature: Date: Coples to: Student Financial A, Student Records Nursing