FORM: ACD01.023 Academic Intervention Interview Form Version No. 3

ACADEMIC INTERVENTION INTERVIEW FORM
This form is to be used by Academic Department for the determination of an intervention strategy. Copies should be kept by the student and Academic Department. Once completed, please forward to the PEO.

Intervention Strategy: Intervention Strategy is an action plan adapted in an attempt to reduce the causes of academic failure. It has been developed to offer you with additional assistance to promoting future success in your studies.
STUDENT DETAILS:
Full Name *

First Name Last Name
Student ID *
Course Enrolled *
Email Address *
example@example.com
Contact number *

Area Code Phone Number
Address *
COURSE PROGRESS DETAILS (Please tick the appropriate option) *

1st Intervention 1st Warning 2nd Intervention
1st Intervention applies for student who is at risk of failure for the first time or the 1 subject/unit of the term

1st Warning applies for student who is at risk of consecutive failure in the same term after 1 Intervention

2nd Intervention applies for student who is at risk of failure in following terms after 1 Warning

Intention to report applies for student who is at risk of failure for 2 consecutive terms and has received 1st Warning. Please use an Appeal form in response to any "Intention to report" letter."
Reasons and any supporting documentation why this intervention strategy should be provided: *
Please attach your files here *

Cancel of
INTERVENTION STRATEGY DETAILS: (Please tick one or more options.)
Prescribed Program

Attending tutorials Reduction in course load Re-assessment Other
Referral to Student Support

Try Attending counseling Receiving assistance with personal issues which are influencing progress Other
STUDENT DECLARATION
I acknowledge receipt of this Academic Intervention and the implementation of the Strategy / Action to be taken by myself. I am aware that if I do not meet the required standards by the agreed dates I am at risk of Wells International College cancelling my enrolment.
Student *

Clear
Date *

Day Month Year
Date
OFFICE USEONLY
Approval Decided By
Signature

Clear
Date

Day Month Year
Date
FORM: ACD01.023 Academic Intervention Interview Form LAST UPDATED: June 2020, Version No.3
Should be Empty:

ACADEMIC INTERVENTION INTERVIEW FORM

STUDENT DETAILS:

STUDENT DECLARATION

OFFICE USEONLY