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Student Services-Requst for Tutor Application

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.

I request tutoring:   

PLEASE CHECK THE BOXES NEXT TO THE TIMES YOU ARE AVAILABLE TO BE TUTORED:
Do NOT mark times you have class or cannot meet.
Not providing sufficient number of hours of availability may result in delays.
Allow a minimum of one week to be matched with a tutor.

 

Monday

Tuesday

Wednesday

Thursday

Friday

8-9

8-9

8:30-9:30

8-9

8-9

8:30-9:30

8-9

9-10

9-10

9:30-10:30

9-10

9-10

9:30-10:30

9-10

10-11

10-11

10:30-11:30

10-11

10-11

10:30-11:30

10-11

11-12

11-12

11:30-12:30

11-12

11-12

11:30-12:30

11-12

12-1

12-1

12:30-1:30

12-1

12-1

12:30-1:30

12-1

1-2

1-2

1:30-2:30

1-2

1-2

1:30-2:30

1-2

2-3

2-3

2:30-3:30

2-3

2-3

2:30-3:30

2-3

3-4

3-4

3:30-4:30

3-4

3-4

3:30-4:30

3-4

4-5

4-5

4:30-5:30

4-5

4-5

4:30-5:30

4-5

5-6

5-6

5-6

5-6

 

 

   5-6

6-7

6-7

6-7

6-7

 

 

   6-7

7-8

7-8

7-8

7-8

 

 

   7-8

I grant this office permission to leave a message regarding my tutorial appointment at the above telephone numbers. I have read, understand, and promise toa bide by Absentee Policy. PLEASE PICK UP POLICY FORM AT TUTORING CENTER AND KEEP IT WITH YOU.

Student Signature:Date: