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Consultation Form: (To Be Accomplished If The Issue(s) or Concern(s) Was/were Not Solved at The Faculty-Student Level.)

This document is a consultation form from the Biliran Province State University in the Philippines. It collects personal information about a student seeking consultation, including their name, program of study, gender, age and contact details. It documents the type of consultation, such as classroom behavior, academics or social matters. It records the date, time and location of the consultation, as well as the faculty member involved. It notes the student's issues or concerns and documents any agreed upon resolutions between the student and faculty. It indicates whether the issue was resolved or unresolved and includes space for notes and signatures of those involved.

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MyMy Margallo
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209 views1 page

Consultation Form: (To Be Accomplished If The Issue(s) or Concern(s) Was/were Not Solved at The Faculty-Student Level.)

This document is a consultation form from the Biliran Province State University in the Philippines. It collects personal information about a student seeking consultation, including their name, program of study, gender, age and contact details. It documents the type of consultation, such as classroom behavior, academics or social matters. It records the date, time and location of the consultation, as well as the faculty member involved. It notes the student's issues or concerns and documents any agreed upon resolutions between the student and faculty. It indicates whether the issue was resolved or unresolved and includes space for notes and signatures of those involved.

Uploaded by

MyMy Margallo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Biliran Province State University


COLLEGE OF ARTS AND SCIENCES
Naval, Biliran

CONSULTATION FORM

Confidentiality Statement:
The undersigned parties ensure that the information herein shall be treated with utmost confidentiality and
the right to privacy of the individual(s) concerned shall be observed.

I. Personal Information

Name: _______________________________________ Program/Year/Section: _________________


Gender: ____Male ____Female Age: _______
Complete Permanent Address: _________________________________ Contact Number: __________
Email Address: _____________________________________________
Parent/Guardian: ____________________________________________ Contact Number: __________

II. Consultation Area

Type of Consultation: ___ Classroom Behavior Academic related concerns


___ Social Matters Others, please specify _________________
Date/Time/Venue of the Consultation: __________________________________________________
Faculty Concerned: _______________________________
Student Issue(s)/Concern: ___________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Based on the above-mentioned issues and/or concerns raised during the consultation, the undersigned parties
agreed on the following:

1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________

Faculty Assessment: ___ Resolved


___ Unresolved
Note:
___________________________________________________________________________________

Concurred: Noted:
________________ ________________ ______________________________
Student's Signature Faculty Signature Dean

(To be accomplished if the issue(s) or concern(s) was/were not solved at the faculty-student level.)

Action Taken: _______________________________________________________________________

Remarks: ___ Resolved


___ Recommended to the concerned office (Please specify: ______________________)

Noted:
_________________ _________________
Program Chairperson Dean

2nd Floor College of Arts and Sciences Building, Main Campus, P. Inocentes St., P.I. Garcia, Naval, Biliran, Province, Philippines 6560
Tel. (053) 507-0076
SUC Level III-1 (Per DBM – CHED Joint Circular # B dated June 21, 2007
Website: www.nsu.edu,ph | Email: oic.president@nsu.edu.ph | Facebook: www.facebook.com/NSUisYOU
“WOW BiPSU!”

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