Name:
Date:
Phone:
Best time to call:
E-mail Address:
Student ID #:
Preferred Method of Contact:
Education Information
Academic Status (number of credits earned):
Number of credits attempted:
Highest Education Level completed:
The grade I typically earned at the highest level of previous education:
I have special needs or require special accommodations (if yes describe):
Financial Aid Information

What is your Financial Aid Status:

What is the name of your Financial Aid Counselor in Student Financial Services:

List what you must do this semester in order to remove yourself from Financial Aid Probation and maintain satisfactory academic progress:

Career Goals

My intended/declared major:

The reason I have chosen my major is:

My dream job:

Possible Challenges to Academic Success

Why do you believe that you did not do well at Southeast last semester?

Check all the challenges which may be barriers to your academic success:

Child or Adult Care Finances Time Management
Study Skills Tired/Fatigued Undecided Major
Illness/Injury Stress Management Family
Mental Illness Housing/Roommate Homesickness
Full/Part Time job Lack of motivation Procrastination
Personal Relationships Alcohol/Substance Abuse  
Lack of or Unclear Goals Involvement in Greek organization  
Disability (describe):
Other (describe):
Academic Information

Number of classes you are taking this semester:

Courses registered for: Anticipated Grade:
Course 1: Grade:
Course 2: Grade:
Course 3: Grade:
Course 4: Grade:
Course 5: Grade:

I plan to study this amount of time each week:

The course that I am most looking forward to this semester:

The course that I am least looking forward to this semester:

Describe your understanding of what it takes to accomplish your academic goals:

Describe how successful you will be in accomplishing your goals:

Describe how you prepare for classes and tests:

Services you plan to use this semester:

Tutorial Services Educational Access Programs Math Lab
University Counseling Services Student Support Services Writing Center
Career Linkages Disability Services Student Activities /Organizations


   

Adapted from the TRIO Student Success Plan from Santa Fe Community College and the Probation Self-Assessment from University of North Carolina at Chapel Hill.

Learning Assistance Programs & Disability Support Services, Academic Support Centers, Southeast Missouri State University.

One University Plaza; University Center Room 302; MS1300; Cape Girardeau, MO 63701; (573) 651-2273