Date: Semester requesting a tutor for: Select One Fall 2009 Spring 2010 Full Name: CCRI Student ID #: CCRI E-mail address (this will be the primary means of contact): Intended Major: Select One Administrative Office Technology Biotechnology Business Administration Chemistry Computer Studies & Information Processing Engineering and Technology Fine Arts General Studies Health Sciences Human Services Legal Studies Liberal Arts Science Technical Studies Undecided Primary Phone #: Secondary Phone #: Participating in Access to Opportunity: Yes No
Participating in Varsity Athletics: Yes No Course name and section you're requesting help with: Instructor:
Days and Times you are available to meet with a tutor: (Example 8-9am,12-3pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please choose your campus:
Select One Lincoln (Flanagan) Campus Providence (Liston) Campus Warwick (Knight) Campus Newport Campus Please select an alternate campus you would like to receive tutoring: Select One Lincoln (Flanagan) Campus Providence (Liston) Campus Warwick (Knight) Campus Newport Campus
I was referred to the Success Center for tutoring by:
Self Friend Instructor Advisor Other
Are you an ESL - English as a Second Language - student? Yes No Problem Areas (check all that may apply): I have trouble understanding the textbook. I have trouble managing time. I have trouble taking notes in class. I have trouble taking notes from the textbook. I have trouble taking multiple choice or true/false tests. I have trouble taking essay tests. I have trouble with course content. Please identify the content that you are having difficulty with: Have you spoken or communicated with your instructor about the difficulties you have had? Yes No Is this the first time you had taken this course? Yes No On average, how much time do you spend studying or doing homework for this course? 0-3 hours/wk 4-6 hours/wk 7-9 hours/wk 10+ hours/wk