Academic Intervention Form

College Success Assessment

Subject:

First Name:

Last Name:

E-mail Address:

Local Mailing Address:

Zip Code:

Term GPA:

Cumulative GPA:

My Academic Adviser is:

Learning from our mistakes is not the easiest path, but it is familiar to many successful people.
Crossing the road that links failure to success will require you to take full responsibility for your learning, motivation and all of the commitments that you make as a student.
Change begins now.

I. Personal Factors that are affecting my academic performance :

	Poor health		Family pressures
	Financial problems		Easily distracted by friends
	Too many commitments		Change in relationship with someone special to me
	Lack of confidence in my abilities		Loneliness
	Other

II. EOU services that I have used:

	Academic Advising		My professors, whenever I need personalized attention, a progress report or answers to questions
	Learning Center / Group Study Sessions / Math Lab		A counselor or other professional on campus regarding my test-taking or other anxieties.
	A quiet place to study.		Career Services to learn about opportunities, such as methods to help me define a career goal.
	Classmates to work with when I need study partners		Library staff for assistance when struggling to perform research for a class
	The assistance of a Learning Center writing tutor before submitting a paper.		The Financial Aid Office about aid that may allow me to work fewer hours and focus more on my studies
	Other

III. Areas that may help me bring out my best performance:

	Lighten my course load.
	Allow myself enough time outside of classes to meet the requirements of my courses.
	Choose courses in which I have appropriate background.
	Select a new adviser.
	Other

IV. Areas where I need to improve to achieve success:

	Follow through with class assignments.		Think about success instead of failure while learning or test taking.
	Come to class prepared.		Learn, understand and practice the information rather than simply memorizing it.
	Take notes that will enhance my studying.		Discover what is important to learn in my classes.
	Concentrate in class.		Complete reading assignments in a thorough, timely manner.
	Use a Daily Planner to help me organize my time and activities, and categorize my priorities.		Participate in class discussions or other activities.
	Attend all classes.
	Other

V. Factors that have a negative influence on my educational performance at Eastern:

	I'm not sure why I'm in college.		I'm not sure I want to be in college.
	I only want to take classes that interest me.		Learning is not one of my priorities now.
	I find it difficult to feel motivated without my family and friends' support.		I haven't made any friends at EOU.
	I'm unsure as to how college fits my long-term goals.		I'm in college only because I was expected to attend.
	I havn't learned to control the stress that college brings to my life.
	Other

First, I will review some of the difficulties that I indentified in the self-assessment.
Second, I will list at least 5 specific ways to reach my potential as a successful student at EOU.
Third, I will put this plan into action this week.

List 5 specific ways I plan to reach my potential as a successful student at EOU:

I would like the following assistance in reaching the goals listed here. (check one or more)

	Periodic phone calls from a faculty or staff member.
	Periodic e-mail communication from a faculty or staff member.
	Periodic visits with a faculty or staff member.
	"Support Group" meeting with students.
	Other

This assessment adapted from materials shared by the College of William & Mary.
Eastern Oregon University - December 5, 2008