STUDENT SUPPORT SERVICES
ACADEMIC CHECK-UP/INTERVENTION PLAN
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
mm-dd-yyyy
Student ID #
Cell Phone #
(999)999-9999
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
GPA
Major
Tusculum Email
*
example@students.tusculum.edu
Your grade level status for this semester
Freshman (0-28 hours)
Sophomore (29-60 hours)
Junior (61-91 hours)
Senior (92+ hours)
How often do you use the Tutoring Center Services?
Never
Once/twice a semester
Bi-weekly
Weekly
More than once a week
Areas of Need: Check the following categories in which you plan to seek services this academic year
Academic Advising (choosing a major/changing majors/course selection)
Cultural Enrichment (lunch seminars and performing arts events)
Computer Skills/Assistance
Scholarships/Grant Aid
Study Skills Enhancement
Student Success Skills
Personal Counseling
Tutoring
Graduate School Info/Visit
Personal Finance Counseling
Mentoring
Informational Workshops
Financial Aid Information
Career Guidance
What are your academic goals for this semester? Be specific (Examples: Make a B in statistics class; finish semester with an overall 3.0 GPA; take Praxis test for education program; choose a major; etc).
Are you interested in graduate school?
Yes
No
If yes, what programs are of interest and what institutions are you considering?
What academic concerns do you have this semester? (For example, is there a class you are concerned about? Are you worried about your GPA)?
What financial aid concerns do you have this semester?
What suggestions or recommendations do you have for ARCHES this year? Is there anything you would like to see us do to assist you?
ARCHES has started a peer support program called the Personally Engaged Enrichment Program (PEEPs) that will connect you with a recent alum or current upper class ARCHES student who can provide support. Are you interested in being paired with a PEEP?
Yes
No
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