United States International University - Africa Guideline for identifying Students for Early Intervention and Prevention of Academic Dismissal Student’s Name: _______________________________ Student ID No.___________ Year of Study: ___________ Course:___________________ Lecturer’s name:___________________________ Identified issue Date: ______________________ Semester: ____________ Student Telephone No__________ Frequency /number of times (tick appropriately) Action taken/Comment by the Lecturer a Student has missed class Twice Thrice Four times Student sleeps in class 25% of the class days 25% of the class days Once 50% of the class days 50% of the class days Twice All the time 25% of the class days 50% of the All the time class days ASSIGNMENTS Student is unable to sit through the lecture Student comes to class intoxicated ( alcohol, drug-related problem) Student comes to class late The student has: Failed to hand in all assignments handed in assignments late Is unable to complete work given Plagiarized assignments and research papers Tick √ All the time Thrice Action taken/Comment by the Lecturer 1 CLASS PARTICIPATION The student : Does not participate in class Does not participate in group activities Has demonstrated difficulty with spoken or written English language that makes participation in class a problem Seems to have difficulties with academic- work life balance Is unable to understand and apply concepts taught Tick √ Action taken/Comment by the Lecturer RELATIONAL SKILLS The student causes class disturbance by: Being rude to the lecturer/other students Being disobedient even after warning has been given Use of mobile phone in the class Violating the rule of not taking drink and snack in the class The student has poorly performed and scored below grade C by mid semester in : All Assignments Continuous Assessment Tests (CAT) Mid semester exam Any other identified issue not specified above: ACADEMIC PERFORMANCE Tick √ Action taken/Comment by the Lecturer General Comments and recommendations: Referral to: 2