Appendix D - Sample Advising Form

Note: This form should be used to document faculty-student meetings related to: 1. Routine advisor- advisee meetings, and 2. Faculty-student meetings that are formally providing guidance on improving student performance, promoting student well-being, or correcting severe or persistent professional behavior issues.

Student:                                                         Location:

Faculty:                                                           Time:

Date:

Mode of Contact:

• Student contacted facultyo Faculty contacted studento Other:

   

  Reason for Contact:

• Routine Advisingo Personal Issueso Academic Performance or Professional Behavior
• Other Student Concern:
• Other Faculty Concerns:

   

  Describe reason for encounter:

   

   

   

   

   

  Describe discussion content:

   

   

   

   

   

   

   

   

   

   

  Result of Encounter:

• Advisement. Please summarize:
• Referral to:
• Leave of Absence
• Withdrawal
• Other:

Measures of Professionalism

(any “no” response requires an explanation in the comments section below.)

Did the student:                                                                              Yes                   No, see comment

Adhere to institutional policies and procedures?

Present self professionally and adhere to the DPAS dress code?

Admit errors and assume responsibility for actions, if necessary?

Arrive on time for scheduled activities and appointments?

Demonstrate sensitivity to power inequalities in professional relationships?

Fulfill responsibilities in a timely manner?

Maintain composure during difficult interactions?

Modify behavior based on feedback?

Request help when needed?

Respond promptly to communication requests?

Acknowledge limits of his/her own knowledge?

Respond receptively to diverse opinions and values?

Maintain the confidentiality of test material?

Refrain from demonstration of other extreme negative professional behaviors?

Comments: