HODGES UNIVERSITY DEPARTMENT OF DENTAL HYGIENE STUDENT LAB/CLINIC COUNSELING AND ADVISING FORM
Student Name ____________________________________ Date: ______________________ LAB/CLINIC Course ______________________________ Course Average to Date: ________________ Absences from Class: _________ Specific Course Recommendations: (check all items requiring improvement) Improved Attendance _______ Improved Effort _______ Improved Class Work _______ Study Early in Evening _______ More Serious Approach to Class Work _______ Improved Preparation _______ After Class Help _______ Tutoring _______ Specific Comments and Recommendations Relating to this Course: ________________________________________________________________________________ ________________________________________________________________________________
Overall Program Progress Current Status: 5 = Very Good 3 = Satisfactory 1 = Needs Improvement
Ability: Aptitude in Subject _______ Motivation _______ Working to Potential _______ Attitude: Attendance/Tardiness _______ Prepared for Class _______ Responsibility _______ Performance: Test grades _______ Attention _______ Participation _______ Cooperation _______ Sim Lab Work _______ Clinical _______ Written Warning Regarding Attendance (Classroom and/or Clinical) This is to certify your attendance record indicates you have _______ hours of absence and _______ tardies recorded as of the date of this report. This action is taken in accordance with the Dental Hygiene Attendance Policy. Please carefully review the Attendance Policy located in the Dental Hygiene Handbook. __________________________ __________ __________________________ __________ Student Signature Date Instructor Signature Date
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Dental Hygiene Program
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