Tutoring Intake Form

*Required Fields

*First Name:
*Last Name:
*Student ID:
*E-Mail:
*Course: (i.e. BIO 1605)
Professor:
Are you a participant in Student Support
Services, TRIO program?
Yes No
Is this course primarily online? Yes No
Are you a student in the accelerated,
evening learning program?
Yes No
What are you having difficulty with in this class?
*What days and times are you available to
meet with a tutor during the school week?
Please see the Tutor Schedule .

Other Comments:

*By checking this box, I agree to come to my tutoring sessions prepared with books, notes, syllabus, and other class materials. I also agree to be prompt to my appointments, and will give my tutor 24 hour notice if I cannot make a scheduled appointment.