Academic Self-Assessment and Recovery Form

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Academic Self-Assessment and Recovery Form intro

Use the form below to assess your academic performance and develop a plan for improvement. This exercise is meant to help you turn your performance around and pass the class(es) in which you are struggling.

However, if you have received two or more Flags, you should complete this form.

If you're not sure how to formulate a realistic recovery plan, please talk with your advisor or with Dean Elizabeth Young; they can help you!

Your Name *

MIT Email *

Advisor Name *

Advisor Email *

Self-Assessment

The goal of this assessment are to help you identify the issues or obstacles affecting your academic performance, and to help you define a plan to recover and pass the classes in which you are flagged.

The following are some of the most common issues and obstacles that affect student performance. Please check all that apply: there is space to add comments if there are issues or problems not covered here.

Academic Concerns

Self-Assessment The goal of this assessment are to help you identify the issues or obstacles affecting your academic performance, and to help you define a plan to recover and pass the classes in which you are flagged. The following are some of the most common issues and obstacles that affect student performance. Please check all that apply; there is space to add comments if there are issues or problems not covered here.

If you had an academic concern that is not listed above, please describe briefly.

Extra/co-curriculars (check all that apply):

If you are involved in a time-consuming activity that is not listed above, please describe briefly.

Personal/Social Adjustment Issues

Other issues not covered above: (describe briefly)

Are there extenuating circumstances that may be having a negative impact on your performance this semester? For example, have you been sick? Having personal or other problems?

If you have not sought help, please now identify at least two resources from whom you will be seeking help.

Define a Recovery Plan: Now that you have assessed what the issues are that are impacting your performance, what action steps will you be taking now to improve your performance? Your plan should be realistic and brief, perhaps bullet points of the action steps can you take now to improve your performance (see Sample Plan). *