Probation Clearance Form For Academic Success
Download a blank fillable Probation Clearance Form For Academic Success in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Probation Clearance Form For Academic Success with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Las Positas College
PROBATION CLEARANCE FORM
For ACADEMIC SUCCESS
□ Fall □ Spring □ Summer Semester 20______
Name: ___________________________________________________ W# or SSN _______________________
Last
First
Address ____________________________________________________________________________________________________
Street
City
Zip Code
Phone
GENERAL INFORMATION (Student to Complete)
Major _____________________________ □ Certificate □ A.A./A.S. degree □ Transfer to: _________________________________
Number of hours worked each week: ___________________ Number of units enrolled this semester: ________________________
Family responsibilities (e.g. married, children, childcare etc.): ________________________________________________________
Support services that I have used at Las Positas (e.g. tutoring, math lab, DSPS):_________________________________________
My lack of academic success, in my opinion, is due to the following factors:
□ Number of hours I worked
Planned Schedule:
□ Did not officially withdraw from a class (and should have)
(Hours per week)
□ Too little time to study
_____________ Work
□ Did not know how to study properly
_____________ Class
□ Need extra help to understand class work
_____________ Study
□ I have □ may have a learning disability
_____________ Other
□ Lack of support (family does not want to help me attend college)
□ Personal problems make it difficult to study
_____________ Total Hrs
□ Lack of motivation
□ Other: ___________________________________________
TO BE COMPLETED WITH A COUNSELOR
Check all that apply:
Academic Status
□ My semester G.P.A. will be: ______________
:
□ Limit total units next term to: _____________
Academic Probation 1
□ Reduce work hours per week to: ___________
□
Academic Probation 2
□ Enroll in College Study Skills / Learning Skills/ Library Skills.
□
Progress Probation 1
□ Sign-up for Tutoring in Building 2400.
□
Progress Probation 2
□ Meet with Counselor ________________ next term.
□
□ Apply for Academic Renewal.
□ See instructor: ______________________________
□ Utilize free services from: _______________ (Integrated Learning Center, English lab, Tutorial, etc.)
□ Enroll in: □ Psychology Counseling 15 (Study Skills) □ Psychology Counseling 10 (Career Planning) □ Other: ________
□ Take assessment placement exam in: □ English □ Math □ Chemistry □ Biology □ ESL
□ Referral made to: □ Disabled Student Services □ EOPS □ CalWORKS □ Financial Aid
□ Schedule a meeting with a Counselor early next semester to develop/update a Student Educational Plan (SEP).
□ Complete Most Recent Grade of Record form for: _________________________________________
□ Suggested course(s) to repeat: ___________________________________________________________
□ Other: ______________________________________________________________________________
□ Short Term Educational Plan: Courses approved for next semester.
Units
___________________________________ (
) _________________________________
(
)
___________________________________ (
) _________________________________
(
)
___________________________________ (
) _________________________________
(
)
___________________________________ (
) _________________________________
(
)
_____________________________
_________
______________________
_______
Student Signature
Date
Counselor Signature
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Corp. 60a - Articles Of Termination Form For A Nonprofit Corporation, Form 943 - Request For Tax Clearance
Legal
Form Mt-39 - Alcoholic Beverages Tax Clearance Return For Tax On Importation Of Alcoholic Beverages Into New York State For Personal Consumption
Financial
Related Categories
Parent category: Education