FORM: ACD01.023 ACADEMIC INTERVENTION INTERVIEW FORM

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:
Name*

First NameFamily Name
Student ID*
Contact Number*
Address*
Email Address*
example@example.com
Course Enrolled*
COURSE PROGRESS DETAILS: (Please tick the appropriate option)*

Intervention LetterWarning 2
•Warning 1 applies to students whose attendance is less than 80% or who have failed more than 50% of the units for the term(courses more than six (6) months in duration). The interview is not required for this letter.

•Intervention Strategy (at risk) applies to students whose attendance is less than 80% or who have failed more than 50% of their units for the semester (courses more than six (6) months in duration), or the term (courses six (6) months or less in duration).

•Warning 2 applies to students whose attendance is less than 80% or who have failed more than 50% of the units for the term of the second or further study periods (courses more than six (6) months in duration).

•Intention to Report applies to students whose attendance is less than 80% or who failed more than 50% of the units for two consecutive study periods. Please use an Appeal form in response to any "Intention to Report" letter.
Reason and any supporting documentation why this intervention strategy should be provided:*
Please attach your files here:

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

Attending tutorials,Reduction in course load,Re-assessmentOther
Referral to Student Support

Attending counselingReceiving a assistance with personal issues which are influencing progressOther
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 Times Academy cancelling my enrolment.
Student Signature*

Clear
Date*

DayMonthYear
Date
OFFICE USE ONLY
Approval Decided By
Signature

Clear
Date

DayMonthYear
Date
FORM: ACD01.023 Academic Intervention Interview Form
LAST UPDATED: June 2022, Version No.4
Should be Empty:

ACADEMIC INTERVENTION INTERVIEW FORM

STUDENT DETAILS:

INTERVENTION STRATEGY DETAILS: (Please tick one or more options.)

STUDENT DECLARATION:

OFFICE USE ONLY