The Gail & Richard Lumpkin School of Nursing - Student Concern Report

This is CONFIDENTIAL report between the School of Nursing Faculty or Instructor and the Program Advisor and Chair. The purpose of the report is to alert the recipients to issues that may impede a student in progress toward degree completion. The faculty or instructor MUST also notify by emailing the Program Advisor and Chair that the report has been submitted.

Date of Submission Date of Submission / MM / DD YYYY
Student Name *
E-Number *
Program *
Student Problem is in (choose any that apply. *
Briefly Describe the Issue
How have you addressed the issue with the student?
Your Name *
Your EIU Email