Instructor Request to Drop Form

Instructions:
In completing this form, you are initiating the instructor/administrative drop process for this student listed below. The student will be notified of your intention to drop him/her from your class in 10 calendar days - regular session (7 calendar days - summer session) from the date listed unless sufficient reason is given.

Internet instructors must also notify Debbie Tucker (870.574.4453) when completing this form, so the student is denied access to their course.

If for any reason, the student or yourself decides not to continue the drop process, you must notify Patricia Sindle (870.574.4492) before the 10 (7 summer) days to stop the drop process. After the 10 days the process is complete.

Course Information:

Instructor Name:

 

Course ID/Section:

 

Course Title:

 

Student Information:

Student ID:

 

Student First Name:

 

Student Last Name:

 
Reason Student is being referred: (You must check at least one of the following) Attendance
Little or no coursework completed
Low test grades
Other: (list below)

If other selected:

Last Date of Attendance and/or access of internet course:  

Mentoring Steps Taken:

(Check All that Apply) Called and spoke with student on the phone
Called and left message on answering machine
Talked to student before and/or after class
Referred to student's advisor
Email with response from the student
Email with no response
Referred to academic assistance (tutoring)
Other: (list below)

If other selected:

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