Orangeburg-Calhoun Technical College-SSS-Tutoring Referral Form

Tutoring Services Referral Form
Student's Name *

First Name Last Name
Email *
example@example.com
Student ID#
TRIO Counselor
Cohort
Date of Referral

Month Day Year
mm-dd-yyyy

Name of course(s)/subject(s): (for academic tutoring). Be sure to include the course name and number.

Course Name and Number

1

2

3

4

Student's Signature

Clear
Date

Month Day Year
mm-dd-yyyy