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Student Academic Report Template

This document is an international student academic report form used to evaluate international military students attending schools in the continental United States. It collects information about the student such as name, country, course details, academic performance ratings, and comments. The form follows regulations for completing forms for international military students studying in the US.

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Joel Dsouza
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70 views2 pages

Student Academic Report Template

This document is an international student academic report form used to evaluate international military students attending schools in the continental United States. It collects information about the student such as name, country, course details, academic performance ratings, and comments. The form follows regulations for completing forms for international military students studying in the US.

Uploaded by

Joel Dsouza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INTERNATIONAL STUDENT ACADEMIC REPORT

(For International Military Students attending CONUS schools.)


(See AR 12-15, AFJI 16-105, and SECNAVINST 4950.4 for forms completion instructions.)

1. FORWARDING ADDRESS (Subsequent training, if applicable, or 2. FROM (Training installation preparing form)
country SAO)

3. STUDENT NAME (Last, First, Middle Initial) 4. GRADE/RANK 5. COUNTRY 6. FMS CASE OR IMET FY AND
WCN

7. COURSE TITLE 8. COURSE ID NO. 9. COURSE MASL 10. DURATION OF COURSE


a. FROM (YYMMDD) b. TO (YYMMDD)

11. DID STUDENT COMPLETE 12. STUDENT WAS AWARDED: (X one) 13. ENGLISH COMPREHENSION LEVEL
COURSE? (X one) a. DIPLOMA/CERTIFICATE OF COMPLETION (Enter test score)
YES b. CERTIFICATE OF ATTENDANCE a. IN-COUNTRY TEST b. CONUS TEST
NO (Explain in Item 15) c. OTHER (Explain in Item 15)
14. STUDENT'S ACADEMIC EVALUATION
a. RATINGS SCALE (Enter in Items b. LANGUAGE PROFICIENCY c. PERFORMANCE IN CLASS
14.b. and 14.c.) (1) COMPREHENSION ITEM RATING
1 EXCEPTIONAL (1) ATTITUDE AND MOTIVATION
2 EXCELLENT (2) SPEAKING (2) ATTENDANCE AND PUNCTUALITY
3 VERY SATISFACTORY
(3) ABILITY TO GRASP INSTRUCTION
4 SATISFACTORY
(3) READING (4) PERFORMANCE IN PRACTICAL EXERCISES
5 UNSATISFACTORY
(Explain in Item 15) (5) PARTICIPATION IN CLASS ACTIVITIES
(4) WRITING (6) POTENTIAL AS INSTRUCTOR
6 NOT OBSERVED
(Explain in Item 15) (If applicable)
15. REMARKS ON ACADEMIC PERFORMANCE, AWARDS, AND OTHER INFORMATION (Use back if more space is required)

16. REMARKS ON STUDENT'S PARTICIPATION IN EXTRACURRICULAR AND COMMUNITY AFFAIRS (On and off training installation)
(Use back if more space is required)

17. EVALUATOR
a. NAME (Last, First, Middle Initial) b. GRADE c. SIGNATURE

18. INTERNATIONAL MILITARY STUDENT OFFICER


a. NAME (Last, First, Middle Initial) b. GRADE c. SIGNATURE

DD FORM 2496, FEB 96 PREVIOUS EDITION IS OBSOLETE. Adobe Professional 8.0


15. REMARKS ON ACADEMIC PERFORMANCE, AWARDS, AND OTHER INFORMATION (Continued)

16. REMARKS ON STUDENT'S PARTICIPATION IN EXTRACURRICULAR AND COMMUNITY AFFAIRS (On and off training installation)
(Continued)

LEGEND (Explanation of Acronyms)


CONUS - Continental United States MASL - Military Articles and Services List
FMS - Foreign Military Sales SAO - Security Assistance Organization
ID NO. - Identification Number WCN - Worksheet Control Number
IMET - International Military Education and Training

DD FORM 2496 (BACK), FEB 96


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