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Request For Tutor Application
Please fill out if you are SPAM BOT
Name:  Date: 
Home Phone:   Work Phone: 

Cell Phone:  Email:

Address: 

City: 

State: 

Zip Code: 

Do we have your permission to give your phone number to your tutor? Yes    No
Course Title and Number: (For MAT 800 you MUST specify level) 
Instructor's Name: Instructor's office location and extension:
What is your current average in this course?
Have you requested a tutor this semester in another subject?Yes    No 
Are you enrolled in the TRIO program?Yes    No 
As part of supporting your work in the classroom, the faculty member will receive a written notification of your working with a tutor and reports ofyour progress throughout the semester. Faculty members are very supportive of the Tutorial Services Program and the students who use this service.