Focus on Retention: Completing the class!
Spring 2015
Name: ____________________________________________________
Course: ___________________Instructor:_______________________
Answer the following questions, then discuss with your group to identify potential
problems. Bring this form to your meeting with me.
1. Number of classes you are taking this semester: __________________
2. Number of hours per week that you are working this semester: ________
Employer:______________________________________________________
3. List of major personal responsibilities (children, spouse, committed relationship,
caring for elderly parent, etc.):
________________________________________________________________
_________________________________________________________________
4. List of weekly recreational activities: (going out, sports, hobbies, TV,
Internet, etc.) ____________________________________________________
________________________________________________________________
5. Rate your time management skills on a scale of 0-100: __________________
6. Are you aware of tutoring services? ________ Have you ever worked with a
tutor? ________
7. Are there other factors that affect your attendance requirement (visa status,
financial aid, insurance, etc. )? ________
8. Other factors that may affect your class attendance/completion of this course
(Note)___________________________________________________________
________________________________________________________________
________________________________________________________________
9. Please give an alternate email address (different from the on file with HCC).
____________________________________________________________
Based on your answers to questions 1-8, list any actions you may need to take to
successfully complete this course. (Use back if necessary)