Tutee Reference Form
To be completed by the applicant:
Applicant name:
Student ID number (if applicable):
Subjects and/or courses interested in tutoring:
We appreciate your sincerity in describing the applicant’s suitability to work as a tutor in the
subject area or courses listed above; the information you provide is confidential and will not be
revealed to the applicant. Please complete and return this form immediately. Applicants are not
considered until their references are received and their application files are complete.
Date:
Name:
Address:
Phone number:
How long have you known the applicant?
In which subject(s) or course(s) s has the applicant tutored you?
Please use your experiences with your tutor to answer the following questions:
Strongly Agree
Somewhat
Agree
Neither Agree
Nor Disagree
Somewhat
Disagree
Strongly
Disagree
Don’t Know
The tutor understood the
subject or course well
It was easy to understand
the tutor
The tutor was able to adapt
to how I learned best
The tutor had a positive
attitude
The tutor did not do
anything unethical, like
finish my assignment for me
The tutor was respectful
and patient
Strongly Agree
Somewhat
Agree
Neither Agree
Nor Disagree
Somewhat
Disagree
Strongly
Disagree
Don’t Know
The tutor was willing to
admit when they didn’t
know something
The tutor was on time to all
of our sessions
The tutor responded to all
emails and phone calls
promptly
I would work with the tutor
again
Do you have any additional comments about the applicant and their ability to tutor?
Do you think the applicant is able to work well with someone who has a learning, mental, or
physical disability?
yes no
Please explain:
Signature:________________________________
After completing the Tutee Reference form, please:
1. Mail it to the address below, or
2. Email it to the address below, or
3. Place it in a sealed envelope and sign across the sealed flap, then return to the
applicant to submit
To submit your reference form, or for additional information, contact Janet Klippenstein,
Learning Services Coordinator:
Student Life & Learning, HA 114
Concordia University of Edmonton
7128 Ada Blvd, Edmonton, AB
T5B 4E4
phone: 780.479.6854
toll free: 1.866.479.5200 ext 854
email: janet.klippenstein@concordia.ab.ca
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