Academic Success Center Request Form for Tutoring Services

Instructors may refer students to receive tutoring. The Academic Success Center staff will contact students after they are referred and assist them in accessing the tutoring services.

Instructor’s Name*

First Last

Instructor’s E-mail*

Student’s Name*

First Last

Student’s E-mail

Course Name*

Type of Class*

PGS
Traditional Course

Description of content that needs to be addressed with the student*

Disclaimer: The staff of the Academic Success Center strives to assist students in their academics. We provide a wide variety of tutoring services, but not every subject matter is able to be represented within our offerings.