University Of Arkansas-Phillips Community-SSS-Tutor Request Form

Tutor assignments are based on the combination of your availability and the availability of the Peer Tutor.

Name*

First NameLast Name

Cell Phone*

(999)999-9999

Home Phone

(999)999-9999

Student ID #

PCCUA Email Address*

example@example.com

Personal Mail Address

example@example.com

Location of Tutoring:

List the course(s) that you are requesting tutoring services: Ex Tech Math, Edmondo Torelli

Tutee's Responsibilities:

In order for the Student Support Services Tutoring Center to operate efficiently we must have full cooperation of all parties involved. The number one priority of the Tutoring Center is that the participant gains the utmost benefit from our Tutoring program which must be reciprocated. Part of you satisfaction is your responsibility. Being considerate of others' valuable time and efforts to make our system work are a priority. In order for the tutor to assist you, you must attend class regularly, take notes during class, attempt the home work assignment given by the instructor before coming to the tutoring session, and bring all necessary materials to the tutoring session.

Please read carefully and mark yes by each statement below. As a Tutoring participant I agree:

To attend all scheduled tutoring session unless otherwise arranged by the Tutor Coordinator.*

To contact the Tutor Coordinator when I am not able to attend my scheduled session or when I am going to be late*

To be on time for my tutoring sessions.*

To come to each session prepared/ready to learn (i.e. bringing your book and homework assignments).*

To ask questions when I do not understand.*

To request another Tutor if I am not satisfied with the one I'm assigned.*

To stay in my tutoring session for the allotted time I am scheduled.*

To ask for accommodations when unforeseen changes occur in your schedule*

To adhere to the Student Support Services attendance poly that states if I miss more than two consecutive sessions I will be dropped from the tutoring program and MUS re-apply for tutoring services.*

Please indicate the times for each day you are available to have a tutoring session. Example Monday: 2pm & 3pm Tuesday: Not Available

Monday

Tuesday

Wednesday

Thursday

Friday

How many tutoring sessions do you desire weekly?

By signing below, you are stating that you have read and agree to the terms and conditions of receiving a tutor.

Please select a signature verification type.

SimpleSMS/TextEmail

Tutor Request Form

Sign & Submit