Academic Self-Assessment
 
Name: ________________________________ Student ID #:___________________ Major: ______________ 
 
E-mail: _________________________________Phone: _____________________ Date: _________________ 
 
Your responses below are confidential and will help us assist you.  Please complete all items and add any additional comments that you believe your advisor would find useful.
1.	List the reasons that contributed to your 
2.	academic difficulty: 
d) _d)  _______________________________ 
    d)  _______________________________ 
c   c)  _______________________________ 
b   b)  _______________________________ 
a) _a)  _______________________________ 
b) _b)  _______________________________ 
c) _c)  _______________________________ 

 

2.	 List your areas of strength/skill: 
1) On average, how MUCH time do you spend WEEKLY preparing for your classes/studying?     					 _____Hours 

2)  On average, how many hours do you spend preparing for an exam? 

_____Hours 

a) _a)  _______________________________ 

 
3.  Specific Classes: Did you experience difficulty with:    Why?   
 
Y   N  Problems with class attendance? 
 
Y   N  Problems with an instructor’s teaching style? 
 
Y   N  Problems with a testing style? (e.g., multiple choice, essay, problems) 
 
Y   N  Are there particular types of courses that give you difficulty? 
 
4. Academic Skills: Did you experience difficulty with:    Why?  
 
Y   N  Reading speed (Do others seem to read much faster than you?) 
 
Y   N  Reading comprehension (Do others seem to get more from the text than you?) 
 
Y   N  The mechanics of written work (spelling, punctuation, sentence construction) 
 
Y   N  The organization of written work in a paper/essay (flow of ideas, detail, order) 
 
Y   N  Quantitative (numerical/math) skills 
 
Y   N  Note-taking skills (getting it all down, organization, losing main points) 
 
Y   N  Ability to identify major/supporting points from the lecture/textbooks 
 
Y   N  Time management 

 

3)   Approximately how many hours each WEEK, on average, do you spend in the
     following activities: 

(a) Team/club athletics (practice & games)   	______________ 

(b) Paid employment                 	     	______________ 

(c) Volunteer/internships   		    	______________ 

(d) Clubs (non-athletic)    			______________ 

(e) Organizations (e.g., Band, theatre)	  	______________ 

(f) Socializing/hanging with friends 	 	______________ 

(g) In contact with your family   		______________ 

5. Personal Issues:  Did you experience difficulty with:    Why? 
 
Y   N   Your residential/living arrangements  
 
Y   N      (1) Having a place to study? 
 
Y   N      (2) Noise/ interference in residence? 
 
Y   N      (3) Roommate/Suitemate/Floormate difficulties? 
 
Y   N  Health problems?  
 
Y   N  Financial problems? 
 
Y   N  Motivation problems? 
 
Y   N  Adjustment to the University? 
 
Y   N  Personal/family problems? 

  

 

       

 

6. Courses:  
List the courses you are taking this semester.
Course    			      Help Needed 
      
_____________________________   ____________________________________________________ 
_____________________________   ____________________________________________________ 
_____________________________   ____________________________________________________ 
_____________________________   ____________________________________________________