Academic Warning Questionnaire

Complete and submit the following questionnaire at least 24 hours before your academic advising appointment. This questionnaire is for YOUR benefit. In order for us to help serve you better, it is important that you are honest and truthful with your answers.

*Required

Contact Information *

First Name

Last Name

Student ID #

What is your CCC student email (eg: cougie@student.clackamas.edu)? *

Email

Are you receiving Financial Aid? *

Yes
No
Unsure

What is your current program of study?

What are your education and career goals?

How many credits do you take during a typical term?

Full time (12-18 credits)
Three-quarter Time (9-11 credits)
Half-time (6-8 credits)
Less than half-time (1-5 credits)
Unsure

Do you work while in school? If yes, how many hours do you work per week?

How many hours do you study per week?

List the classes that you did not like or had difficulty with:

Have you visited with your instructors during their office hours? If yes, how often?

What do you do when you don't understand an assignment or class material?

What do you find most challenging about your classes? ( For example, taking tests, group work, taking notes, large assignments, study skills, etc.)

What campus resources have you used?

How often do you see an academic advisor?

List 3 ideas of how to improve your grades in your next term:

Time Management: Do you...

Time Management: Do you...
	Yes	No	Sometimes
Keep lists prioritizing tasks that need to be completed?	Yes	No	Sometimes
Break big assignments down into smaller more manageable parts?	Yes	No	Sometimes
Use a planner or cell phone calendar for time management / organization?	Yes	No	Sometimes
Have a designated study area free of distractions?	Yes	No	Sometimes
Establish regular study times each day?	Yes	No	Sometimes
Use your syllabus to plan ahead for projects / assignments / tests?	Yes	No	Sometimes

Note Taking: Do you...

Note Taking: Do you...
	Yes	No	Sometimes
Take notes during class?	Yes	No	Sometimes
Review pervious class notes before the next class meeting?	Yes	No	Sometimes
Get copies of class notes if you are absent?	Yes	No	Sometimes
Use class notes to help study for tests?	Yes	No	Sometimes

Reading for understanding: Do you...

Reading for understanding: Do you...
	Yes	No	Sometimes
Take notes while you are reading class materials?	Yes	No	Sometimes
Highlight the main ideas in the text as you read?	Yes	No	Sometimes
Review your reading notes before the test?	Yes	No	Sometimes

Test Taking: Do you...

Test Taking: Do you...
	Yes	No	Sometimes
Use a specific method for remembering / memorizing class material?	Yes	No	Sometimes
Give yourself several days to study before a test?	Yes	No	Sometimes
Read through the entire test before turning it in?	Yes	No	Sometimes
Review graded tests to determine what you missed?	Yes	No	Sometimes
Form study groups with friends / classmates	Yes	No	Sometimes

Class Participation: Do you...

Class Participation: Do you...
	Yes	No	Sometimes
Attend every class session?	Yes	No	Sometimes
Arrive to class on time?	Yes	No	Sometimes
Ask questions during class?	Yes	No	Sometimes
Participate in class discussions?	Yes	No	Sometimes
Turn in all of your assignments on time?	Yes	No	Sometimes
Know how to use Moodle?	Yes	No	Sometimes

School/Life Balance: Do you...

School/Life Balance: Do you...
	Yes	No	Sometimes
Receive support of family and or friends?	Yes	No	Sometimes
Manage your work and school responsibilities?	Yes	No	Sometimes
Balance your social life and/or family responsibilities?	Yes	No	Sometimes

Regarding your studies and academic progress, are there any other challenges you are facing that you would like to share or need help with?