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Academic Referral

by Academic Referral Team

September 23, 2008

Student's Name:
Grade %:
Date:
Course:
Instructor's name, e-mail address, and work extension:
I am initiating this academic referral for the following reason(s): Excessive Absences
Student Abruptly Stopped Attending Class
Student Requested Assistance
Missing Assignment(s)
Poor Academic Performance
Other
What steps have you taken to assist this student? Contact Parent/Guardian
Met With Student Before/During/After Class
Recommended That Student See Me During Cardinal Time
Recommended That Student See Me After School
Other Action Taken To Assist Student
What can you tell us that will help as we handle this case?

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