Request A Tutor Form

Please check which semester you will need a tutor:
Semester:   Fall    Spring    Summer
Term:         Full-Term    A-Term    B-Term

Name:              Student ID Number:

Address: 

City:          Zip Code: 

Telephone Number:      College Email:

Cell Phone Number:

* May we contact you by text message? Yes    No      Who is your provider?

Curriculum (Major):

Subject in which tutor is needed (Please complete a separate request for each course)

Course Title
Course Number
Instructor

 

Please indicate how you were referred for tutoring services:

 

* Available Hours (The times that you will be able to meet with the tutor) *

Monday
Tuesday
Wednesday
Thursday
Friday


Semester Course Schedule:

Monday:
   
Tuesday:
   
Wednesday:
   
Thursday:
   
Friday:

 

* Check one:

Is English your second Language   Yes No
Please keep my tutoring application confidential   Yes No
I would be willing to work in a group tutoring session.   Yes No
If a tutor is not available, I would be willing to join a small study group.   Yes No

 

Please select the campus you will be attending?
Cumberland Bedford

 

Please enter comments. (Example: Request Specific Tutor, Special Accommodations, etc.)

 

I give my permission to release my telephone number to other members of a study group.

E-Signature:  

Please click "Submit" only once.
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