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Tutoring Request

Form

This form is intended only for use by students already registered with the Access Center. Upon submission of this form you will be contacted by a Tutoring Center Representative to schedule an appointment.

Name:  
Student I.D.#:  
Phone #:  
Metro E-mail:  
Accessibility Coordinator:   
Course(s) you are requesting tutoring: Example: ACC-2010   

Time(s) you are available for tutoring. (Please be specific)  
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:


Background Information - Learning

  1. What type of learner are you?  (check all that apply):
    Auditory learner
    Visual learner
    Kinesthetic learner



  2. What are your academic strengths?  


  3. What are your academic areas of concern related to this tutoring request? 


  4. Other information that would be helpful to know about my tutoring needs:  


  5. I give permission for my Access Center Coordinator to share additional disability related information, as appropriate, with the Tutoring Coordinator to maximize my tutoring experience:    


  6. I give permission for the Tutoring Center Coordinator to share disability related information, as appropriate, with my assigned Tutor to maximize my tutoring experience:    


 

 

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