Academic Student Success Coaching Student Intake Form
Name
Name
First
Last
STUDENT ID NUMBER
Best way to contact me:
Best way to contact me:
email (personal)
email (live@esu.edu)
text
Phone
Other
Other
MAJOR
ACADEMIC COACHING AREAS OF INTEREST
*
ACADEMIC COACHING AREAS OF INTEREST
Organizational Skills
Goal Setting and Action Steps
Class Attendence
Enhance Study Skills
Enhance Test Taking Skills
Enhance Note Taking Skills
Effective Time Management
Changing Majors
College Transition
Other
Other
List three academic goals for the upcoming semester
1
2
3
My signature below indicates that I will support the academic coaching process; I will schedule with my success coach on w-fish.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
I do not want to participate in the academic coaching program
I do not want to participate in the academic coaching program
No, Thank you.