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Please provide your application information below.
Student Name:
*
Date:
*
Degree Program:
*
Phone:
*
e.g. 888.555.1212
Email:
*
Address
Street:
*
Apt./Suite:
City, State:
*
Zip Code:
*
Class Level:
*
select...
Graduate - 1st Year
Graduate - 2nd Year
Graduate - 3rd Year
Graduate - 4th Year
Undergraduate - 1st Year
Undergraduate - 2nd Year
Undergraduate - 3rd Year
Undergraduate - 4th Year
Tutoring needed for:
*
(Class name and number)
Monday
Time(s):
Morning
Afternoon
Evening
Tuesday
Time(s):
Morning
Afternoon
Evening
Wednesday
Time(s):
Morning
Afternoon
Evening
Thursday
Time(s):
Morning
Afternoon
Evening
Friday
Time(s):
Morning
Afternoon
Evening
Saturday
Time(s):
Morning
Afternoon
Evening
Sunday
Time(s):
Morning
Afternoon
Evening
I would like assistance with:
*
Test taking
Note taking
Understanding the textbooks
Organization
Please check all that apply to you.
It will be helpful to your Tutor if you can pinpoint specific areas you want to strengthen:
What is your preferred learning style?:
*
Visual
Auditory
Kinesthetic
Have you discussed your concerns with your instructor yet?:
*
Yes
No
Would you like information on student support workshops?:
*
Yes
No
Academic and Disability Support
Academic and Disability Support
Contact Information