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NHS Peer Tutoring Request Form
Please fill out this form if you would like to request a peer tutor. The NHS Peer Tutoring Coordinator will do his best to fulfill the request as soon as possible.
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* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Grade
*
Choose
9
10
11
12
Student Email Address
*
Your answer
(Optional) Student Cell Phone Number (would be given to the tutor to help schedule tutoring sessions)
Your answer
1st Course (include both class name and teacher name) in which Tutoring is Desired
*
Your answer
(if applicable) 2nd Course (include both class name and teacher name) in which Tutoring is Desired
Your answer
(if applicable) 3rd Course (include both class name and teacher name) in which Tutoring is Desired
Your answer
Days/Times Available (please be as specific as possible)
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Email Address
*
Your answer
Parent/Guardian Phone Number
*
Your answer
(Optional) Do you have someone you have worked with in the past and would prefer to have again? (Please note that it is not guaranteed that a requested match will be made.)
Your answer
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