From: ______________________________   Date:____________________________

 

Dear Advisor:

I have concerns about _____________________Õs progress in my class, specifically

                                                (studentÕs name)

______________________________________________________________________________.

                                                (describe concerns)

 

 

I need his/her input to help me understand him/her better and make a plan.  Please gather the following information and return the form to me by _______________.  Thank you.

(date)

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Guidelines for Gathering Student Input

(To be used during conversation/interview with student)

 

Student _______________________­­­_____  Grade ______________  Date __________________

 

 

1.     IÕm concerned that you are having some difficulty at school and IÕd like to talk with you about it and get your input.  Explain/describe the concerns.

 

 

 

2.    How do you feel about school this year?

 

 

3.    Is there anything going on in your life that might be contributing to what is going on at school?

 

 

 

4.    Have you had similar problems before in school?  If so, what did you and your teacher(s) try?  How did it work?

 

 

 

5.    What do you think might help you in school?

 

 

6.    Is there any adult in school whom you feel connected to?

 

 

7.    I may share this with the school Educational Support Team, also known as EST.  It is a group of school staff members who gather and share ideas about how to help students succeed.  If EST decides to hold a meeting, would you like to participate?  Would you like anyone else (family member, teacher, other) to participate?   The meeting will likely take place on a Monday from 3 to 4 pm.

 

8.    Is there anything else you can share with me that might help me (us) to help you?