OFFICE OF SPECIAL SERVICES - STUDENT SCHEDULE
NAME TODAY’S DATE
Last First preferred name or nickname, if any
UNIV ID# N MAJOR
EMAIL @nyu.edu
TELEPHONE
(Daytime &/or Cell)
PREFERRED EMAIL (please print)
Level: Freshman (<31 credits) Sophomore (32-63 credits) Junior (64-96 credits) Senior (>97 credits)
INSTRUCTIONS:
1) Please fill in your entire class and work schedule in the boxes below.
2) X out time slots that you would prefer your tutoring sessions. Please indicate a variety of slots to increase your
chances of being matched.
3)
Please Note: Session scheduled during times with an * will NOT take place in the TRIO Office
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
9 9:30
9:30 10
10 10:30
10:30 - 11
11 11:30
11:30 - 12
12 12:30
12:30 – 1
1 1:30
EXAM HOUR
1:30 – 2
EXAM HOUR
2 2:30
2:30 – 3
3 3:30
3:30 - 4
4 4:30
4:30 - 5
5 5:30
5:30 – 6
4) List the subjects for which you would like tutoring in the order of importance (up to 3 subjects are allowed).
Leave the following slots blank for staff use: Tutor, Day/Time, # of sessions, Grade and Cancelled.
Subject
Tutor Day/Time # of sessions Grade
Canceled
Y N (Date)
(Do Not Write Below; For Office Use Only)
5) Answer to evaluation question #1:
YES
NO LAST DATE OF SERVICE ____________________
STUDENT ACTIVITIES PROFILE (Do Not Write Below; For Office Use Only)
I. Student’s Name ______________________ Interviewed on ______________ by ___________________________
Probation? Yes No
II. Tutoring Attendance
Early Warning:
BMS ______ CM ______ CS ______ EN ______ EG ______ Math ______ PH ______
Subject(s) ____________ ____________ ____________ ____________ ____________
Suspension Letter: Sent on ________ Reason: Attendance MS
3
Mand. Meeting / Reinstated_________
date
Termination Letter: Sent on ____________ Termination Appealed on ____________ Reinstated_________
date
CSI Complete:
Yes No
Rescheduled/Extra Hours:
Type Date Subject Notes Initials
______ _______ ________ ________________________________________ ______
______ _______ ________ ________________________________________ ______
______ _______ ________ ________________________________________ ______
III. Activities: Advisement; Trips; Workshops; Etc.
Contacts / Advisement Trips
Date Focus/Min. Date Focus/Min Date Location Date Location
Student Contacts _____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
_____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
_____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
_____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
AC Walk-In Hours _____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
_____ _____/_____ _____ _____/_____ _____ _______________ _____ _______________
Mandatory Meeting
(Prob. Only) YES _____ _____ Other Activities/Events
Date Min. _______________ 1 _____ 2 _____ 3 _____ 4 _____
_______________ 1 _____ 2 _____ 3 _____ 4 _____
Workshops _______________ 1 _____ 2 _____ 3 _____ 4 _____
Financial Aid 1 _____ 2 _____ 3 _____ 4 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Financial Literacy 1 _____ 2 _____ 3 _____ 4 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Fit Friday 1 _____ 2 _____ 3 _____ 4 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Graduate School 1 _____ 2 _____ 3 _____ 4 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Academic Workshop 1 _____ 2 _____ 3 _____ 4 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Writing Center Workshop 1 _____ 2 _____ 3 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
MS3
YES _____ _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Date Min. _______________ 1 _____ 2 _____ 3 _____ 4 _____
Career Fair Event 1 _____
. _______________ 1 _____ 2 _____ 3 _____ 4 _____
TRIO Study Days 1 _____ 2 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
TRIO Celebration/Holiday Mixer 1 _____ _______________ 1 _____ 2 _____ 3 _____ 4 _____
Student/Tutor Cancellations & No-shows:
C or
N/S?
Initiated
by
S or T?
Date
Subject
Reason
Initials
C or
N/S?
Initiated
by
S or T?
Date
Subject
Reason
Initials
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_______________
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