John Jay College of Criminal Justice Early Academic Referral Form

John Jay College of Criminal Justice

Early Academic Referral Form

Academic Support Services

Room 010W (212) 237-2163

The Early Academic Referral System is a program designed to help students improve academic performance. This program allows professors to alert the coordinator of any student who is not making satisfactory progress. The referral form below provides an easy method to refer students to the program. Once a student is identified, the Early Warning Coordinator will work with him or her in conjunction with the College's academic advising system and other support services in an effort to improve classroom performance. To maximize academic interventions, please send this form at your earliest convenience. Whenever possible, please speak to the student before completing this form. When completed, this form will be sent electronically to Francis, Director of Freshman Peer Mentoring Program. EarlyAcademicReferral@jjay.cuny.edu.

For your convenience, you may also print the Early Academic Referral form. Please send the completed form to Howart Francis, First Year Advisement & Freshman Peer Mentoring 010W.

Early Academic Referral Form

Professor

2.	Professor's E-mail

3.	Student (last, first)

Course

Section

6.	Attendance/Participation

	(Select all that apply.)
	Absent more than one day during the first two weeks of class.
	Consistently late for class.
	Does not participate in class.
	Leaves class early.
	Sleeps in class.
	Other
	Not Applicable

7.	Academic reasons for referral

	(Select all that apply.)
	Under-prepared for class.
	Lack of preparation/withdrawal from classroom activities.
	Low test scores/low assignment scores.
	Decline in quality of assignments/test performance.
	Difficulty with assignments.
	Difficulty communicating orally and/or in writing because their native language is not English - refer to the Center for English Language Support (Room 1201 N).
	Difficulty with note taking, test taking and study skills � refer to Reading and Study Skills Center
	Difficulty with writing assignments � refer to Writing Center (Room 2450N).
	Difficulty with math assignments � refer to Learning Enhancement Center (Room 011W).
	Difficulty with science assignments � refer to Math and Science Resource Center (Room 4300N).
	Other
	Not Applicable

8.	Non-academic reasons for referral

	(Select all that apply.)
	Illness
	Overt statements regarding difficulties. Refer to Counseling Dept.
	Overt changes is demeanor (i.e. anxiety, aggression, depression, etc.)
	Work conflicts
	Family Conflicts
	Other
	Not Applicable

9.	Faculty/student interaction

	Yes, I have spoken to the student about this referral.
	No, I have not spoken to the student about this referral.

10.	Instructor�s recommendation

	Student should withdraw from class.
	Student Should remain in class and seek academic interventions

11.	Suggestions for Improvement (referral for additional assistance, tutoring, study skills, test-taking skills, counseling, etc.):

12.	Additional Comment � if requesting tutoring, be specific on problem areas & what the student & tutor should work on: