Salem State University: S.S.I. Form

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Student Success

Please enter as much information as possible. Required fields are marked with an asterisk *.

Academic Concerns

Class Attendance

Class Participation

	Has not purchased textbooks
	Student does not take notes in class

Assignments

Writing ability not at college level

General Concerns

	Sudden decline in academic performance
	Missed appointments
	Distressed about being an undecided major
	Displays unrealistic academic expectations
	College level work seems too difficult
	Student doesn't use Salem State email
	Student is not making satisfactory academic progress

Overall Grades to Date

Academic Comments

Personal Concerns

Please check
all that apply

Self-disclosed family issues

Lack of emotional support from home

Chronic illness

Untreated acute illness

Recent removal from peer group

Recently experienced a traumatic event

Self-disclosed relationship difficulties

Other personal issues

Personal Comments

Adjustment to Salem State

Please check
all that apply

	Excessive Internet/gaming use
	Homesickness
	Not settled in (bare walls, empty closets, belongings still packed)
	Doesn't leave his/her residence hall
	Not involved in campus organizations or activities
	Insomnia or oversleeping
	Roommate issues
	Has difficulty establishing relationships with peers
	Overly focused on social aspects of college life

Adjustment Comments

Financial Difficulties

Please check
all that apply

	Unresolved financial aid issues
	Working too many hours
	Work schedule conflicts
	Student or student's family has had a change in financial status

Additional Comments