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Annex 9
STRICTLY CONFIDENTIAL
THE CHINESE UNIVERSITY OF HONG KONG
Department/ Programme/ Division of
_______________________
Report on Meeting with Student
Student Name:
___________________
Student ID: ___________________
Student*:
Type*:
Undergraduate/ Postgraduate
Local/ Mainland (Homeland:_____________________________________)
International (Origin: ______________/ Place of Study: ____________________)
Others (e.g. EAS): _____________________________________
Year of study:
__________
Appointment Date & Time:
_____________ Appointment Venue:
_________________
1. Issue(s) Discussed:
Study
Financial
Family
Physical
Interpersonal
Emotional
Others (please specify): ______________
3. Necessity for Follow-up Appointment:
No
Yes. Suggested date/ month: _________________________________
Student has been informed of the referral/ follow-up action
Yes
No
4. Other comments:
_____________________________________________________________________
* Please circle as appropriate
Remarks: 1. This form should be seen by designated personnel only.
2.
A copy of this form should be given to the student upon request.
2. Actions and Recommendations:
Refer to psychological counselling
Refer to Learning Enhancement Officers (for non-local students)
Seek emergency grant/ loan from college or university
Others (please specify):_______________________________________________________
Name of Advisor: _____________________________________
Position: ____________________________
Date: ___________________________
