Request for Tutorial Services

Student Name *

Date

Degree Program *

Campus *

Phone *

e.g. 888.555.1212

Email *

Class Level *

Tutoring needed for *

(include class number below)

Tutoring needed for

(include class number below)

Tutoring needed for

(include class number below)

Please specify what days, and times you will be avaliable for tutoring sessions.

Which academic skills do you find challenging? *

Please check all that apply to you.

Which specific areas do you want to strengthen?

Have you met with faculty to discuss your concerns? *

Yes

No

How do you usually prepare for an exam?

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