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Peer Tutoring Center Referral
Please complete this form so that a peer tutor can be matched to you.
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* Indicates required question
Email
*
Your email
Name of student
*
Your answer
Email of student
*
Your answer
List the subject(s) for which the student is requesting tutoring
*
Your answer
Time of Tutoring Preference (select all that apply)
*
Morning session (7:30 am to 7:53 am)
Afternoon session (3:15 to 3:45)
Personal tutor requested (the student will be matched with a peer tutor and they will work out a schedule)
Duration of tutoring (how many weeks does the student need a tutor)
*
1 week
2 weeks
3 weeks
4 weeks
the rest of the semester
two weeks prior to exams
Person referring the student (please be sure to communicate with the student if you are referring them to the PTC at Northwood)
*
Studet
Parent
Counselor
Teacher
Staff member
Student's Guidance Counselor's Name
*
Your answer
Referring person's name, email, and cell phone
*
Your answer
Anticipated start of tutoring (enter the date)
*
Your answer
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