Complete this form if you would like an Upward Scholars tutor spring semester

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* 1. What is your first name?
(Please use the name you used when you registered for classes. For example, "Garcia" or "Garcia Lopez.")

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* 2. What is your last name?
(Please enter the name you used when you registered for classes. For example, "Maria" or "Maria Elena.")

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* 3. Please list all email addresses we can use to contact you.

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* 4. Please list all phone numbers we can use to contact you.

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* 5. What is your date of birth? (For example, 05/03/1987)

Date

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* 6. What is your ID number at the college you are attending this spring?
For Cañada, this is your G number. For example, "G01030483."
If you are attending more than one college this spring, write your ID number for all colleges you will attend.

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* 7. In the boxes below, please list:
All classes that you took in fall semester (for example, Grammar and Writing III or ESL 400)
The grade you received in each class (for example, A- or C+)
If you don't know your grade, write the grade you think you will receive.

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* 8. When are you available to meet with a tutor? (Please choose ALL times that you are available.)

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* 9. You will meet with your tutor once a week for 1 to 2 hours. What days and times will you be able to meet?  
(For example, Mondays, 3 to 6 pm.  List ALL days and times you can meet.)

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* 10. Where can you meet with your tutor? (Please choose ALL the places that you can meet.)

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* 11. Why do you want a tutor?

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* 12. If you want help with your classes, what classes do you want help with? (For example, Grammar and Writing III)

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* 13. Why do you want to have an Upward Scholars tutor?

Thank you for requesting an Upward Scholars tutor.  We will do our best to find a tutor for you.

If you have questions or need emergency help with a class, please contact Tania at tania@upwardscholars.org 
or call (650) 649-8883.

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