Tutor Request

All fields in bold are required.

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Your Name
First
Last
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E-mail
*
Current Address
Street Apt. #
City State Zip
*
GV Student ID
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Home Phone --
*
Work Phone --
*
Cell Phone --
*
I request a tutor for the following course (each request must be on a separate form.)
Course Title Course Number/Section
Professor Day/Time
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List the specific difficulties you are having or anticipate having in this course.
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In order to provide the best tutoring for you, list the study strategies you have already used with this course.
*
When would you prefer to meet with your tutor?
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I have attended the Math Lab and met with Diane Hintzsche. Yes No Not Applicable
*
Indicate your preferred method of receiving tutoring services. Face to Face
Phone
Online
No Preference
I consent to the Academic Enrichment Center contacting the professor for this course.

Signature
Date