Tutor Request Form


You will be notified by email when your appointment has been scheduled.


Date:


Student Information

Student Name:
Sport:
Email Address:
Phone:


Course Information

Course Name & No. (ex. UGC111):
Course Instructor:
Class Meets:
Do you attend class regularly? Yes No
If no, please state why:    
I need to meet with a tutor:
2-3 times per week
to review for tests only 		once a week
1 time only 		 
Additional Comments:


Statement of Understanding

I understand that, by being assigned a tutor for the course(s) requested, I am agreeing to meet with the tutor on an agreed upon schedule or as determined by my academic advisor. I have been advised of my responsibilities and I understand that failure to meet with the tutor can lead to the discontinuation of my tutoring services.
I Agree