Focus on Retention: Completing the class!
Spring 2012
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: ________
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
________________________________________________________________
________________________________________________________________
________________________________________________________________
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)