Learning Center—Tutor Request Form

Please be advised that the information provided on this form may be shared with The Teaching and Learning Center's personnel and tutors. It will be used primarily for tutorial session appointment scheduling. This information will be kept confidential within the realm of The Teaching and Learning Center. Please note that our director does possess the right to confer with your instructor regarding your attendance and participation in class.

 

Email Text

*First Name

Middle

*Last Name

*E-mail Address

Phone

Subject or Academic Concern - If applying for CSI Program, please put CSI in the text box.

Course

Section

Instructor

Degree: Associate/Bachelor's/Provisional

College Major

List dates and times you are most likely to be available for a tutoring session.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Have you ever requested assistance from the center before?

Yes

No

Additional Comments

* indicates a required field

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