Academic Intervention Measures

Please complete this “Academic Intervention Measures” (AIM) form to generate an outreach to students who may be experiencing difficulties in your courses: excessive absenteeism, poor quiz and test scores, lack of work submitted, difficulties using technology. Many times an early intervention helps the student to be successful. Once submitted, a member of the Academic Service team will then follow up with the student to offer academic support.

*Required

*Student Name:


*Student ID:


*Course Name:


*Course Number:


*Instructor:


*Semester:


*Date: (MM/DD/YYYY)


Reason:

 Poor Class Attendance
 Poor Quiz/Test Performance
 Unsatisfactory Class Participation
 Enhancement of Technology Skills

Other:


Security Password (Please type the word ):