Student Performance Review Cover Sheet

Date of Initial Meeting with Student: _______________
 
Faculty Members Present (Must include Director of Training and Student's Advisor):
 




 
Summary of Problem (include specific behaviors, setting, and who first identified the problem):
  
  

  
 
Date of Faculty Review Meeting ________

Faculty Recommendation:
 
   ___ No action required
   ___ Remediation required (attach copy of plan)
   ___ Dismissal recommended (must be reviewed and approved by
         Department Chair and Dean)
 
RECOMMENDATION APPROVED:
 
Student's Advisor or Mentor ________________________  Date ___________
 
Director of Training _______________________________  Date ___________
 
 
Date of Student Feedback Meeting _________
 
Student Comments:
 

Signature of Student: 

__________________________________________________
                                       (Does not indicate agreement)

Date:   ______________