Fillable Peer Tutor Request Return completed form to: Ciaran (Saint Michael's College)

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Peer Tutor Request Return completed form to: Ciaran (Saint Michael's College)

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Peer Tutor Request
Last Name: _______________________________
SMC email: _______________________________
Cell Phone: _______________________________
To assist in providing you the appropriate support please check all that apply:
Time Management
Test/exam preparation
Effective textbook reading
Effective note-taking strategies
Other skill/topic (briefly describe)
___________________________________________________________________________
Course # Course Title Instructor’s Signature
(Confirms the student has met with you to discuss
their progress and desire to work with a peer tutor)
_______________ ___________________________ _______________________________________
_______________ ___________________________ _______________________________________
_______________ ___________________________ _______________________________________
In order to connect you with a tutor available to meet your needs, please indicate the level of tutoring you
anticipate using per course:
1 hour weekly
o Course(s) ____________________________________________________________________
2 hours weekly
o Course(s) ____________________________________________________________________
Intermittent (ex. before exams but not meeting consistently week-to-week)
o Course(s) ____________________________________________________________________
Date: _________________
First Name:
_______________________________
Preferred Name: _______________________________
Middle Initial: ____
Return completed form to: Ciaran Gilmore, Peer
Tutoring Coordinator cgilmore@smcvt.edu
Updated 9/2020
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Peer Tutor Request Return completed form to: Ciaran (Saint Michael's College)

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Completed 1 February 2021

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