Application to Request Peer Tutoring Services
All questions must be answered or your application will not be considered.
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Name *
First and last name
Student ID number *
Email *
Phone number *
What class do you need help with? *
How many hours per week do you study for this class? *
Availability - please list all days and time you are available *
Have you met with your instructor outside of class? *
Required
Have you talked to any of your classmates about studying together? *
Required
Do you take notes in class *
Required
Have you received peer tutoring at MCC before? *
Required
By signing below, I confirm that I kept the attached Applicant’s Copy of Student Success Center Guidelines for Tutoring and agree to follow all tutoring guidelines listed.  In addition, I understand that in submitting this application for a peer tutor, I agree to allow the MCC Student Success Center to obtain/verify any academic information related to the subject I am requesting.  I also understand that assignment of a tutor is at the discretion of the Student Success Center, that there is no guarantee that I will be assigned a tutor, and that tutoring for some subjects may only be available in an “open lab” format in the Student Success Center.          *Signature of applicant: ___________________________                     Date: ____/____/_______Thank you for your application for Peer Tutoring services.  If you have any questions, please contact the Tutoring and Career Services Coordinator (Teresa Klostermann) at 641.844.5751.             *
It is the policy of the Iowa Valley Community College District not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status. If you have questions or complaints related to compliance with this policy, please contact the Vice President of Administration, serving as the District Equity Officer, 3702 S. Center Street, Marshalltown, IA 50158, 800-284-4823, Equity@iavalley.edu, or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560 Facsimile: (312) 730-1576, TDD 800-877-8339 Email: OCR.Chicago@ed.gov.  
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