Administrative Failure Form

A student may receive an AF if they do not meet the standards of engagement listed in the course syllabus, if they violate the Student Code of Conduct, or if they demonstrate unsafe or unsatisfactory performance in clinical, practicum, internship, or lab settings as determined by faculty or agency supervisor evaluation . The administrative failure is recorded on the student's academic record as a grade of "AF" and is calculated in the GPA as an "F". An AF drop may affect a student's financial aid, loans, Veterans' benefits, health insurance, and academic progress.

"*" indicates required fields

Term*

Student Name*

First Middle Last

Student ID#*

Student Academic Program*

CRN*

Course #*

Course TItle*

Note: If you are awarding more than one AF, you must complete a separate form for each course.

Reason for Administrative Failure in this course*

Student stopped attending class (Instructor must have documentation of attempts to contact student. Please upload them below.)

Code of Conduct Violation (See student handbook for Code of Conduct process.)

Unsafe or unsatisfactory performance in clinical, practicum, internship, or lab setting (Please give brief explanation of issue below.)

Attendance Documentation

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 50 MB.

Brief explanation of unsafe or unsatisfactory performance in clinical, practicum, internship, or lab setting

Instructor Name*

First Last

Instructor Signature*

Today's Date*

Administrative Failure Form

Follow RVCC

rivervalleycommunitycollege