Republic of the Philippines Document Code: CCS-BF-014

UNIVERSITY OF ANTIQUE Revision No.: 01

Sibalom, Antique
Telefax No. (036) 543-8161 Effectivity Date: January 2016
E-mail: ua@antiquespride.edu.ph Page: 1 of 1

COLLEGE OF COMPUTER STUDIES

E-mail: ccs@antiquespride.edu.ph

STUDENT RED FLAG FORM

______ Semester, AY 20___ - 20___

Instructor __________________________________________ Date: __________________

Schedule _________________________________________ Course: _________________

To the College Dean:

Transmitting to you the list of students with problems in my class.

STUDENT Nature of Problem(s) Recommendation(s)

(Academics / Behavioral / Others) (counseling / remedial
class / others)

May I request that the students with academic problems be given remedial class on

_________________________ at ________________________________________.
Students with behavioral problems are recommended to be referred to the Guidance Office.

______________________________
Instructor’s Signature

Action Taken: Remedial Class Approved

Referred to the Guidance Office on _______________________________

Others (specify) _________________________________________________

_________________________________
Dean