Student Concern Form

CORE VALUES: Inconsistent Behaviors and Corrective Goals

For each core value, examples of inconsistent behaviors are provided. If an instructor observes a student who exhibits any of these behaviors and feels the behaviors present a challenge to the student’s potential as a teacher or to the learning environment, the instructor should identify these behaviors below and schedule a meeting with the student to discuss these behaviors and set corrective goals. If the goals are not met, the issue will be referred to the Director of Education.

Critically Reflective Practice
Inappropriate, inadequate or lack of response to feedback
Inability to identify or acknowledge behaviors that are inconsistent with the core values
Failure to evaluate the effects of choices and actions on others
Unwillingness or inability to make changes based on feedback
Other: / Description of behavior:
Professionalism
Lack of professional integrity
Disrespectful behavior to instructor, peers, children, parents, or other professional partners
Inability to articulate one’s professional responsibilities
Inability to communicate effectively (through writing, speech, etc.)
Chronic issues with punctuality and/or absences, appropriate dress, or professional presentation of self
Other: / Description of behavior:
Diversity
Devaluing the perspectives of others
Use of language/behaviors that are dismissive, intolerant, or disrespectful
Voicing support of stereotypical perspectives
Unwillingness to understand and meet the diverse educational needs of learners
Other: / Description of behavior:
Multicultural Perspectives
Dismissive, intolerant, or disrespectful of alternate cultural perspectives
Discriminatory behaviors/practices
Lack of effort to understanding New Mexico’s unique linguistic and cultural diversity
Other: / Description of behavior:
Collaboration
Does not listen to, or respect, the contributions of others
Disruptive to teams’ work
Fails to work with others
Monopolizes work and/or conversations
Other: / Description of behavior:

Comments

Please provide any other information with regard to your contact with the student and their responses.

Corrective Goals

Please identify specific measurable goals expected to correct the behavior. These goals should be supported by observable behaviors the student must demonstrate.

Example:

Goal: Student X will be more productive in collaboration with peers.

Behaviors: Student X will be on time for group meetings. He/she will complete work assigned by the group.

Goal: Student Y will use strategies to identify ownership of their viewpoints, rather than generalizing as truth.

Behaviors: When student disagrees, student will use statements such as “I hear what you are saying, and I disagree. I believe…”

Date to revisit: ______

Course Number, Section & Title: ______

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Student printed name Signature Date

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Instructor printed name Signature Date

Outcomes: Please provide a brief summary of the outcomes of this student concern process and what resolution occurred or if any future action needs to be considered.