Request for Tutoring

Name Name First Last
University Student ID #
Home Phone Home Phone - ### - ### ####
Mobile Phone Mobile Phone - ### - ### ####
May we text you periodically with reminders and timely information to support your success?

May we text you periodically with reminders and timely information to support your success? Yes No
Castleton Email
Major(s)
Class Year

Class Year Freshman Sophomore Junior Senior
Did you learn English as a second language?

Did you learn English as a second language? Yes No
Did either of your parents ( biological or adoptive) graduate with a four-year college degree or higher?

Did either of your parents ( biological or adoptive) graduate with a four-year college degree or higher? Yes No
Do you have a documented physical or learning disability?

Do you have a documented physical or learning disability? Yes No
Did you receive a Pell Grant for this academic year?

Did you receive a Pell Grant for this academic year? Yes No
If you wish to elaborate on your knowledge of the language, do so here:
Please list the course for which you are requesting a tutor.
Subject
Course #
Course Title
Course Instructor
Preferred Tutor (if applicable)
Primary Reason:

Primary Reason: To improve comprehension of course material To help improve study skills Other Other
How often would you like to meet with a tutor?

How often would you like to meet with a tutor? Weekly More than weekly As needed (specify) As needed (specify)
Participant Expectations

I understand that as a participant in the Academic Support Center tutoring program, I am expected
• Check Castleton email for information about a request
• Approach the tutoring session with a commitment to learning and a willingness to work hard
• Come to sessions prepared so that the tutoring time can be used efficiently (I will try the assigned work myself before the tutoring session and work independently between sessions)
• Arrive on time for all sessions or inform the tutor well in advance when I cannot attend a scheduled session (Three unexcused sessions could result in a denial of tutoring service from that specific tutor)
• Ask for assistance from the Academic Support Center staff or a faculty member whenever necessary
• Complete evaluations of tutors in a timely and thoughtful manner
• Inform the Academic Support Center of any problems or concerns I may have which are related to the tutoring services
Checking this box signifies that I have read the above expectations and agree to abide by them.
Confidentiality and Student Signature:

Important! The Academic Support Center staff handles student information confidentially to assist in verifying your TRIO eligibility to the Federal Government and/or providing you with academic/personal services. Your signature below verifies your agreement with the three statements below.

1. I authorize the Academic Support Center to obtain disability data, obtain financial aid documents, verify citizenship and verify my academic standing (when necessary) to either provide or initiate Student Support Services for me.

2. I give the Academic Support Center permission to request feedback from my professors and I agree to meet with the Academic Support staff if my professor(s) indicate that my performance is unsatisfactory.

3. I certify that the information I have provided on this application is correct to the best of my knowledge. I understand that if any of this information is found to be false, my eligibility for Student Support Services will be jeopardized.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Request for Tutoring

Request for Tutoring

Please list the course for which you are requesting a tutor.

Participant Expectations