The student actively rebuffs, avoids change, or does not recognize own limitations The student does not accept constructive feedback The student does not maintain professional composure in stressful situations Other / Comments: Integrity Concern related to student integrity Concerns related to integrity may identify potential Honor Code violations. These should be reported to the Honor Council. The policy and process can be found current Student Catalog. Honor Council Chair: Honor Council faculty advisor: Tom Ecay Other / Comments: Other problematic or unethical behaviors not listed above: Date of Incident: Description of the student’s behavior or event that occurred: Yes No Did you provide feedback to the individual(s) named? Did you document the feedback? (please attach any documentation) Have you reviewed the contents of this report with the individual(s) named? Other / Comments: If completing electronically; please print and sign as indicated. I have read this report and discussed it with the person completing this form: ______________________________________________ ______________________ Student Signature Date ______________________________________________ _______________________ Submitter’s Signature Date Submitted signed form to: Dr. Thomas Kwasigroch, Associate Dean of Student Affairs Student written reply submitted Procedures: Concerns related to student professional behaviors will be reported on the Student Professionalism Report form. The report will be signed and submitted to the Associate Dean for Student Affairs who will forward a copy to the Executive Associate Dean for Academic Affairs. The Associate Dean for Student Affairs will review each report and meet with the student who is the subject of the report on an individual basis. Past experience suggests that over 90% of such reports will be addressed with individual student counseling.
The student actively rebuffs, avoids change, or does not recognize own limitations The student does not accept constructive feedback The student does not maintain professional composure in stressful situations Other / Comments: Integrity Concern related to student integrity Concerns related to integrity may identify potential Honor Code violations. These should be reported to the Honor Council. The policy and process can be found current Student Catalog. Honor Council Chair: Honor Council faculty advisor: Tom Ecay Other / Comments: Other problematic or unethical behaviors not listed above: Date of Incident: Description of the student’s behavior or event that occurred: Yes No Did you provide feedback to the individual(s) named? Did you document the feedback? (please attach any documentation) Have you reviewed the contents of this report with the individual(s) named? Other / Comments: If completing electronically; please print and sign as indicated. I have read this report and discussed it with the person completing this form: ______________________________________________ ______________________ Student Signature Date ______________________________________________ _______________________ Submitter’s Signature Date Submitted signed form to: Dr. Thomas Kwasigroch, Associate Dean of Student Affairs Student written reply submitted Procedures: Concerns related to student professional behaviors will be reported on the Student Professionalism Report form. The report will be signed and submitted to the Associate Dean for Student Affairs who will forward a copy to the Executive Associate Dean for Academic Affairs. The Associate Dean for Student Affairs will review each report and meet with the student who is the subject of the report on an individual basis. Past experience suggests that over 90% of such reports will be addressed with individual student counseling.
quillenprofesssionalreportform_rev8-14.docx