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Tutoring Request

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:  
Disability Coordinator:   
Semester Requesting Tutoring:  
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 study techniques do you currently use? (Check all that apply)
    Non-Distracting Setting
    		 Set Study Schedule
    Tutoring
    Review Notes after Class
    		 Join Study Group(s)
    Keep Current on Reading Assignments
    Highlighting Key Points
    		 Use Flashcards
    Meet with Professors

  3. Which of the items listed below best describes your concentration and attention in class? (Check all that apply)
     Attentive
    		  Prepared
    		  Distractible
     Engaged
    		  Disinterested
    		  Anxious

  4. Of the following, check those areas that are difficult. (Check all that apply)
     Understanding Class Lectures
    		  Memorizing Fact/Figures
     Learning Formulas
    		   Writing Papers
     Following Directions
    		  Meeting Deadlines
     Attending Class Regularly
    		  Time Management
     Concentrating when Studying
    		  Organizing my Thoughts
     Sequencing Steps of a Task
    		  Understanding Reading Assignments

  5. Describe how you study for tests:
  6. Describe how you study for tests:  

  7. What are your academic strengths?  

  8. What are your academic areas of concern? 

    9. Other information that would be helpful to know about me for tutoring purposes:  

    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:    

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