Learning Center
LC 105
TUTOR REQUEST
Name: , Date: 20
(last) (first)
Tel. #:
Cell H W
E-
Male 
Female
mail: Student ID:
DVC COURSE FOR WHICH TUTORING IS REQUESTED
Course Title: Instructor:
Is English your first language?
Yes
/
No
If no, first language is:
1. What days and times can you come for tutoring? (Example: MW, 2-5 p.m.)
2. Below, please place a check mark next to all of the times you are available FOR TUTORING.
Mondays 8:30 , 9:00 , 9:30 , 10:00 , 10:30 , 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30 ,
2:00 , 2:30 , 3:00 , 3:30 , 4:00 , 5:00 , 6:00 , 7:00
Tuesdays 8:30 , 9:00 , 9:30 , 10:00 , 10:30 , 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30 ,
2:00 , 2:30 , 3:00 , 3:30 , 4:00 , 5:00 , 6:00 , 7:00
Wednesdays 8:30 , 9:00 , 9:30 , 10:00 , 10:30 , 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30
, 2:00 , 2:30 , 3:00 , 3:30 , 4:00 , 5:00 , 6:00 , 7:00
Thursdays 8:30 , 9:00 , 9:30 , 10:00 , 10:30 , 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30 ,
2:00 , 2:30 , 3:00 , 3:30 , 4:00 , 5:00 , 6:00 , 7:00
Fridays 8:30 , 9:00 , 9:30 , 10:00 , 10:30 , 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30 ,
2:00 , 2:30 , 3:00
Saturdays 11:00 , 11:30 , 12:00 , 12:30 , 1:00 , 1:30 , 2:00 , 2:30 , 3:00
FOR OFFICE USE ONLY
:
TUTOR FIRST MEETING
DAY AND TIME
ADD DROP ADD DROP
TUTOR NOTIFIED ADD LIST
SCHEDULE CARD WORKSHEET
DAILY MASTER TUTEE NOTIFIED
OfficialForms/StudentFolder/TutorRequest 2018
To submit this form:
1. Fill in all appropriate fields.
2. Save the file to your computer or device.
3. Email the saved file as an attachment to hleedvc.edu.