University of Southern Mississippi Logo

Academic Concerns Reporting Form

Please complete this form to report a student who demonstrates the need for additional academic support. This includes excessive absences, multiple missed assignments, or academic skill concerns. Students reported to the Academic Concerns Team will be contacted by a team member to discuss options for additional support.

Concerns regarding Academic Integrity should be reported here. Concerns regarding misconduct, interpersonal behavior, mental health, physical wellbeing, or safety should be reported here. For concerns that span multiple areas, please select the form that represents the most pressing concern. For additional guidance, please email advisementcenter@usm.edu.

Background Information

Enable additional features by logging in.

Your full name:

Learn more

Required

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Reason for this Report:(Required):

This field is required.

Date Concern Arose(Required):

This field is required.

Time of incident:

Specific location:

Student Information

Involved party 1

Name

ID Number (without w)

Questions

What course is the student enrolled in?(Required) This field is required.

What is the format of this course?(Required)

Face-to-face Synchronous online/Chat (virtual meeting patterns) Asynchronous online (no required class meetings)

This field is required.

Select all methods you have used to resolve this concern thus far:(Required)

General group message or announcement to full class/multiple recipients re: concerns and success tips Alert to Academic Advisor Private message to USM email Private message via Canvas Phone call Text

You must make at least one selection.

Select all that apply for this student at this time:(Required)

Recommend student contact instructor directly Instructor will consider allowing late work submissions Instructor will consider extra credit opportunities Student can potentially pass course Student is unlikely able to pass course, recommend to drop/withdraw if possible

You must make at least one selection.

Please give a description of concerns.(Required) This field is required.

If appropriate, do you prefer to be contacted upon resolution or case closure?

Yes No

This field is required.

Background Information

Student Information

Questions

Submission