CHANGE OF TUTORING STATUS
Student Name: ________________________________
Semester/year: ____________________
Tutor Name: __________________________________
All changes must be approved by the Tutor Coordinator. This change is for (check all that apply):
Hours tutored per week
Day(s)/time(s)
Transfer to new tutor
Change of course
Student withdrawal from tutoring
Student withdrawal from class
Tutoring suspended
Other (specify): ________________________________________________________
________________________________________________________
Current Information
New Information
Course: __________________________________
Course: __________________________________
Days/times: _______________________________
Days/times: _______________________________
No. of hrs. per week: ________________________
No. of hrs. per week: ________________________
Other (explain): __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
This change is:
Semester-long Temporary: From _______________ To _______________
Effective date of change: ________________ Semester Week #: _______________
Reason for change: _______________________________________________________________
_______________________________________________________________
Date: ________________
Date: ________________
For office use only:
Approved
Denied
Comments: _____________________________________________________________________
_____________________________________________________________________
Revised: 08/2018