Fillable Academic Alert Tutoring Student Intake Form (Durham Technical Community College)

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Academic Alert Tutoring Student Intake Form (Durham Technical Community College)

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Academic Alert Tutoring
Student Intake Form
Durham Technical Community College is dedicated to helping you achieve academic success.
The Academic Alert Tutoring Program is designed to offer assistance to students who may be
in danger of not completing a course successfully. If an instructor sends a form to the
Academic Alert Tutor, we will contact you to offer assistance or a referral to outside resources
to help you stay on track. To ensure we have your most current contact information, please
provide the following information:
Name: ____________________________________________________
Student ID number (NOT your SSN): ____________________________
Current phone number: _______________________________________
Current email address:
_______________________________________
If there is an academic or life issue for which you would like assistance this semester, please
explain the issue here:
Revised 8/10/17
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Academic Alert Tutoring Student Intake Form (Durham Technical Community College)

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Completed 1 October 2020

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