Date:
Semester requesting a tutor for: Select One Summer 2012
First Name: Last Name
CCRI Student ID #:
Phone Number: Tutoring will not begin until we contact you by phone.

CCRI E-mail address:

Course Subject you're requesting help with: Course Codeeg. MATH 0500
Instructor:

Days and Times you are available to meet with a tutor: (Example 8-10am,12-4pm)
The more availability you have the more success we will have in matching you with a tutor.

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

Are you an ESL - English as a Second Language -  student?
Yes   No
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