Today's Date is: 
 

 

LEC Tutor Request Form

 

Personal Information

Date:              (Example:    1/8/08)

Semester:     (Example:     Spring '08)

First Name:        Last Name:   

Sex:    Male    Female

Race:   

Traditional Student:    Yes    No

Email Address:      (Example: lecenter@semo.edu)
Do you check email?    Yes        No

Student ID #    

Address:           City:        Zip:   

Telephone:      (Example:     573-651-2000)
Answering Machine:    Yes        No             Best Time To Call:    

Have you received tutoring in the past?    Yes    No        If so, when?    

Major:               College:

Current Student Level:   Beginning Freshman        Freshman          Sophomore           Junior           Senior 

                  Graduate Student            Second Degree Seeking           Other 

Course Information

 

Course Number: (Example: MA134-01) Course Name: (Example: Algebra I)

The information provided will assist in developing an appropriate plan for helping you in this class.
Please answer all of the following questions.

Is this your first time taking this class?    Yes    No
Do you attend class regularly?    Yes    No
Are you having difficulty taking notes?    Yes    No
Have you approached your instructor for assistance?    Yes    No
Are you completing all assignments for this class?    Yes    No
Do you enjoy this class?    Yes    No
Do you know how to study for class?    Yes    No
Have you attended any workshops on study skills?    Yes    No

How many hours do you spend studying for this class?   
My present grade in this course is:    (Example:    A, B, C, D, or F)

Please list your current work and class schedule and any other times you are unavailable
for tutoring:

* By submitting this form I authorize the University Tutorial Services and Student Support Services to access my academic and class records and to contact my academic advisor for verification purposes.  I understand that these records will be held in the strictest confidence.