Shri Swami Samarth Education Society’s

BASAV ENGINEERING SCHOOL OF TECHNOLOGY (B.E.S.T), Zalki

144/3, A/P Zalki, Tal: Indi, Dist: Vijayapura – 586204, Karnataka, India
(Aff. VTU Belagavi, Approved by AICTE New Delhi)

STUDENT COUNSELING FORM

DATE

STUDENT NAME SEM.

1. REASON FOR COUNSELING:

Identify reason:

2. GENERAL OBSERVATIONS:

a. Attendance:

 Punctual
 Habitually Late
 Other: (Explain)

b. Appearance:

 Neat, Clean
 Other: (Explain)

c. Attitude:

 Willing, Eager, Pleasant

 Other: (Explain)
3. Is student experiencing difficulty meeting any situation?  YES  NO

EXPLAIN:

4. Is corrective action needed?  YES  NO

EXPLAIN:

5. Next counseling session:

6. Counselor's comments:

STUDENT NAME STUDENT SIGNATURE DATE

COUNSELOR NAME COUNSELOR SIGNATURE DATE