Madisonville Community College
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Student's Last Name
Student's First Name
Instructor's Name
Course Name and Number
Please check all that apply to the student
This is a distance learning class
Poor attendance (for distance learning classes, this may mean the student has not logged in to Blackboard)
Poor test performance
Excessive tardiness
Lack of class participation (For distance learning classes, this may mean the student does not respond to email, does not participate in discussion boards, etc.)
Incomplete assignments
Written work is below standards (not on time or incorrectly prepared)
Poor quality of oral work
Other (non-academic distractions, technical difficulties, etc.)
Class performance
The student is passing my class at this time
The student is not passing my class at this time
Discussion with student
I have discussed my concerns with the student
I have not discussed my concerns with the student
Tutoring for student
I recommend this student for tutorial assistance
Please provide any additional details regarding the above concerns
I last had contact with this student on
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Madisonville Community College
2000 College Drive Madisonville, KY 42431
Phone (270) 821-2250 | Fax (270) 824-1866 |
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equal educational and employment opportunity institution.
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