Tutor Request Form
Exit this survey
*
1
. Personal Information
Personal Information
First Name:
Last Name:
Room Number:
Phone Number:
Email Address:
Classification (Freshman, Sophomore, Junior, Senior, Post-Bacc):
Major:
*
2
. Please enter your PSC student ID number.
Please enter your PSC student ID number.
3
. For which classes are you requesting peer education/tutoring?
For which classes are you requesting peer education/tutoring?
Course 1:
Instructor:
Course 2:
Instructor:
Course 3:
Instructor:
*
4
. What times are you available?
What times are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
5
. Who referred you to the peer education/tutoring program?
Who referred you to the peer education/tutoring program?
6
. Who is your Advisor?
Who is your Advisor?
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