ASU Nina Scholars Instructor Feedback Form
You have been identified as an instructor of a Nina Scholar recipient attending Arizona State University.  Please take a few moments to complete this form regarding the progress of your student at the semester midpoint.

The Nina staff will review and respond to your submission as time permits.  In most circumstances, students will be copied so that they too understand your perspective on how they are doing in your class.  

Should you have any questions, please contact the Nina Scholars program staff at nina.scholars@asu.edu.  
Email *
SSM107-01: Release of Student Information
Should you have any concerns about the release of student information as it relates to FERPA, ASU policy does allow a release of information with other school officials for a legitimate educational interest (see SSM 107–01: Release of Student Information):

Personally Identifiable Information

Personally identifiable information may not be released without the student’s consent, except under the following circumstances or to the individuals/organizations listed below or otherwise as permitted by law. These releases are permissible, not required. 

1. ASU school officials with a legitimate educational interest. See definitions of “school official” and “legitimate educational interest” below in the Definitions section of this policy. 

and

Required Record of Releases of Information

Records of release or disclosure shall be available for inspection only to the student, university personnel responsible for custody of the record, and authorized representatives listed in this policy under Conditions of 
Release of Educational Records above.

The act dictates the following exceptions to the requirement for the recording of release of information:
  1. requests by or disclosures to the student
  2. requests by or disclosures to university personnel having a legitimate educational interest in the record
  3. disclosures pursuant to a student’s written consent when the consent is specific with respect to the party, or parties, to whom the disclosure is made
Instructor's preferred title
Optional: please let the Nina Scholars staff know how to address you in our response to your submission.  
The response will address your submission feedback in general terms as the scholar will be copied in the email.
Instructor First Name *
Instructor Last Name *
Student First Name *
Student Last Name *
Course Code *
ex: ENG 101
Identify the current (or best estimated) semester grade for the student in your course. *
Rate the student according to each of the following categories: *
5-Excellent
4-Good
3-Average
2-Fair
1-Poor
Insufficient Basis
Attendance
Participation
Work Quality
Assignments
Preparation
Comprehension
WHAT SCORE DID THE STUDENT RECEIVE IN THE MAJOR ASSIGNMENTS LISTED BELOW?
(Major assignments could include an exam, quiz, paper, or other.)
What score did the student receive in Major Assignment #1, if any? *
If no major assignment has been given, type "none."
What score did the student receive in Major Assignment #2, if any? *
If no major assignment has been given, type "none."
What score did the student receive in Major Assignment #3, if any? *
If no major assignment has been given, type "none."
What score did the student receive in Major Assignment #4, if any? *
If no major assignment has been given, type "none."
What score did the student receive in Major Assignment #5, if any? *
If no major assignment has been given, type "none."
Please share any comments, concerns, or recommendations to make about your student. *
Submit
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