Request for Tutor

     *First Name:                      

     *Last Name:                     

     Social Security Number: 

     Address:                         

     City:                                 State:      Zipcode: 

     Home Phone:              Work Phone:    Cell:

     *Email Address:         

     * What type of student are you?

1. Full-time
2. Part-time
3. Evening

     Curriculum:                    

     Please list course: name, number and Instructor for which a tutor is needed:

     Course Name:                      

     Course Number & Section:  

     Course Instructor:                

 

   I could use support in the following areas: (check all that apply): 

1. Background for the course
   
2. Decreasing Math Anxiety
   
3. Decreasing Test Anxiety
   
4. English Speaking/Writing/Reading
   
5. Improving Study Skills
   
6. Increasing Motivation
   
7. Note-taking skills
   
8. Textbook Reading
   
9. Time Management
   
10. Writing
    
11. Other

     Days and hours that you are free to tutoring, taking into consideration your work and family commitments:

    

      Enter any additional comments or questions you may have: