Student Administrator Instructions

Thank you for your willingness to help with the administration and collection of the Student Feedback Form.

1. Ensure that the instructor leaves the class room after reading instructions to class
2. When all the forms have been completed, collect them and any unused forms and put them into the envelope provided
3. Sign below to assure that all procedures were followed
4. Place this (signed) sheet into the provided envelope
5. Seal the envelope
6. Return the envelope to:
a. Middletown 8:00am � 5:00 pm, inside the Academic Vice Presidents� Office (Library 222).
b. Middletown after 5:00pm, in drop box outside the Academic Vice Presidents� Office (LIB 222). 
c. Newburgh 8:00am � 7:30pm, in drop box in Central Office on 2nd floor.





The procedures listed above have been followed.

Student Administrator Name (print):  ________________________________________________

Date:   _________________________________________________________________________

Signature:  _____________________________________________________________________