Emergency Financial Assistance Program
Student Progress Report
Student ___________________________________ Student ID Number __________________
Course /Section ___________ Semester/Year _________
TO THE INSTRUCTOR
The above student has applied for emergency funs and has given consent for you to release the
information requested below. We are interested in your perspective on their academic
performance. Please remember to add your name and date at the bottom.
After you complete this form, email it to Karen Mosley at firstname.lastname@example.org as soon
as possible so we can process the student’s application.
Please check the boxes below that describe this student’s performance and/or status in your
Does the student:
☐ Attends class
☐ Demonstrates an understanding of the subject matter
☐ Participates in or contributes to class
☐ Turns in assignments on time
☐ Is earning passing grades on assignments and tests
Student has been absent for _____ out of _____classes during this semester.
Please describe this student’s performance in class.
Instructor Name _____________________________________ Date __________________