Tutoring Request Form

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. What are your academic strengths?:




7. What are your academic areas of concern?:




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:     YES NO

I give permission for the Tutoring Center Coordinator to share disability related information, as appropriate, with my assigned Tutor to maximize my tutoring experience:     YES NO