Fillable University of Evansville - Student Application for the Academic Coaching Program

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University of Evansville - Student Application for the Academic Coaching Program

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The University of Evansville - Student Application for the Academic Coaching Program form is 1 page long and contains:

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  • 5 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

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Student Application for the Academic Coaching Program
Name_______________________________________________Date__________________
Student ID Number_________________________Circle freshman sophomore junior senior
E-mail___________@evansville.edu Cell Phone________________________
Major __________________________ Advisor___________________________
GPA____________________________
Why would you like an Academic Coach?
____ Assist with better managing my time to get everything done.
____Accountability to ensure I’m on track.
____Ideas for techniques to review academic material.
____All of the above.
____Other___________________________________________________________________
What are your strengths?
What areas would you like to improve?
____Writing ____Grades in certain subjects
____Stress level ____________________
____Time management ____________________
____Organization ____________________
Coach Preference: Male ___________ Female_______
Referral by faculty/Staff:
Signature______________________________Printed Name___________________________
____________________________________________________________________________
I,________________________________________________________, affirm that I have read
the Code of Responsibility for Security and Confidentiality of Data signed by my Academic
Coach. (see example on back)
I give permission for my Academic Coach to have access to:
____Grades ____Correspondence ____Athletic Coach ____Other
St
Francie Renschler
(812) 488-3250, fr25@evansville.edu
Academic Advising
Clifford Memorial Library, Room 264
Date
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University of Evansville - Student Application for the Academic Coaching Program

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Completed 17 April 2020

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