Appendix D - Sample Advising Form

Elon University PA Program in Charlotte – Advising Form

Purpose:

This form should be used to document faculty-student meetings related to:

1. Routine advisor- advisee meetings

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 Name:

Location:

Faculty:                                                          

Time:

Date:

Mode of Contact: ☐ In-person ☐ Virtual ☐ Phone

Contact Initiated By: ☐ Student contacted faculty ☐ Faculty contacted student ☐ Other:_____________________

Reason for Contact
☐ Routine Advising

☐ Academic Performance or Professional Behavior

☐ Personal/Other Discussion

☐ Other Student Concern: __________________________________________

☐ Other Faculty Concern: __________________________________________

Describe Reason for Encounter:

Describe Discussion Content:

Result of Encounter

☐ Advisement (Summarize): __________________________________________

☐ Referral to: __________________________________________

☐ Leave of Absence Request

☐ Withdrawal Request

☐ Other: __________________________________________

Recommended Follow-Up
☐ Faculty Advisor

☐ Course Director

☐ Faculty Subject Matter Expert

☐ Program Director

☐ Dean

☐ Other: __________________________________________

Comments / Additional Notes

Faculty Signature: ___________________________ Student Signature: ___________________________