Academic Support Center - Peer Tutoring Request Form

Personal Data First name: *
Last name: *
Student ID number: *

Your student ID is required for this form. Please follow these directions.

Click here to log in to MyAACC, locate the "Self Services" tab, select "Student", then select "My profile" under Academic Profile.

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Street address: *
City: *
State: *
Zip code: *
Phone number: (XXX-XXX-XXXX) *
Second phone number: (XXX-XXX-XXXX)
E-mail address: (College e-mail Only) *

(Note: Requests are processed via e-mail.)

Educational Background Major: *
Referred by: *
Are you a SASP member? * yes no
First time using a tutor? * yes no
First language (if other than English):
Current course load (Number of credit hours): Credit Hours *

Tutoring Needs Course name: (e.g. College Algebra) *

Do not know your course name or number?

Your Course Name and Course Number are required for this form. Please follow these directions. Click here to log in to MyAACC, locate the "My Courses" tab, and choose the term next to "Course Schedule for:". Then view the section titled "Courses I'm Attending:", highlight the needed information and press Ctrl + C (to copy the information) and return to the Peer Tutoring Request form find the appropriate field and press Ctrl + V (to paste information).

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Course number: (e.g. MAT-131) *
Section number: *
Professor's name: (last name only) *
Current grade in class: *
Willing to work in a small group: * yes no Specific tutor requested:

In what areas are you having difficulty? (Check all that apply)

test taking
understanding test questions
not enough time to finish test
reading speed
understanding textbook
writing papers

understanding class lecture
recalling information
note taking
time management
distractibility
other (please indicate below)

Student Tutoring Agreement

*, a registered student of Anne Arundel Community

(Please type your full legal name in the box above)

College, am applying for tutoring in the

* term,

(choose a term)

By checking the REQUIRED boxes below, you agree to the following conditions:

* I understand that budgetary restraints limit the time I can be tutored to fifteen hours per course. (Please note: Students registered with the Disability Support Services office may be eligible for extended tutoring time. Any student who needs additional hours should contact the Coordinator of Tutoring to request approval.)

* I understand that it is my responsibility to keep appointments with my tutor. If I am unable to meet at the agreed upon time, I will call the tutor in advance to reschedule. I agree that if I miss more than two appointments, I will forfeit my right to continue tutoring.

* I agree that I will not attempt to utilize my tutor as an editor or homework proofreader. My tutor's job is to review or clarify concepts and help with study preparation. My tutor's job does not include writing or assisting with graded assignments. All work that I submit for grading will be done independently.

* I agree to be honest when signing the tutor's hour log after each session and when filling out an evaluation of the tutor at the end of the semester.

* I agree to report to the Coordinator of Tutoring if any problems with the tutoring arrangement should arise.

Please type your legal name in the Student's Signature box and press 'submit request' to request a tutor. Typing in your legal name serves as your official electronic signature.
Signature (type your name): *

Date: 1/08/2009