BLOOMSBURG UNIVERSITY TUTORIAL SERVICES
Request for a Peer Tutor
APPLICANT INFORMATION
Name:
Date:
BU ID:
Cell Phone:
Current year by established credits
How did you learn about UTS?
Freshman
Flyer
Friend
Email:
Sophomore
Online
Are you a member of the Act 101/EOP program? YES
NO
Junior
Senior
Professor
Graduate Student
Walked In
Other _______________
Are you a member of the TRiO program? YES
NO
AVAILABILITY
Please check the times that you are available to be tutored.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9-10
Closed
Closed
10-11
Closed
Closed
11-12
Closed
Closed
12-1
Closed
Closed
Closed
1-2
Closed
Closed
Closed
2-3
Closed
Closed
Closed
3-4
Closed
Closed
Closed
4-5
Closed
Closed
Closed
5-6
Closed
Closed
Closed
6-7
Closed
Closed
Closed
7-8
Closed
Closed
Closed
8-9
Closed
Closed
Closed
COURSES
Please list the courses you would like to be tutored in.
Department
Course Number
Section
(3 digits)
(2 digits)
Course Name
Instructor
If there is not a tutor immediately available, would you be interested in working with a guided study group? YES
Would you be interested in meeting with an academic coach to work on your study strategies? YES
NO
NO
COMMENTS
Special Notes:
If available, would you prefer to be tutored in a language other than English? YES
NO
If yes, what language(s)?
OFFICE USE
Posted
Tutor Information
Name:
Index
Comp.
Sched.
Email:
GA Initials:
Phone #:
Date:
Tutee Emailed:
________
Tutee Confirm:
_________
Day/ Time:
Group:
Grouped with:
Cancel
Both Notified:
_________
GA Removed from:
Index
Complete Schedule
GA Initials:
Date:
Both Notified:
_________
Bloomsburg University Tutorial Services
Tutee Contract
Mission Statement
The mission of University Tutorial Service (UTS) is to assist Bloomsburg University undergraduates in experiencing
learning success, to help as many student clients (tutees) as possible to strengthen their academic performance, to
provide individualized assistance, to foster interest in BU courses, and to aid tutees in achieving learning independence.
As a Tutee, I will:
 Faithfully maintain my tutoring schedule.
 Come prepared for all tutoring sessions.
 Be on time for all tutoring sessions.
 Call my tutor 1 hour in advance when cancelling a session.
 Attend class.
 Read and prepare course material in advance of all tutoring sessions.
 Complete an evaluation form at the conclusion of all scheduled sessions.
 Notify my tutor of any changes to the weekly schedule and then notify the office of any
 Changes agreed upon, either temporary or permanent.
 Notify the office if I no longer require tutoring.
UTS and my tutor will NOT:
 Do any course work for me.
 Take the place of the professor.
 Offer walk-in appointments.
 Replace my going to class.
Attendance policy:
 If I notify my tutor that I am canceling my session a total of three (3) times in a semester, my tutoring privileges will
be revoked for the remainder of the semester. (Cancellations must be made one (1) hour prior to the session by
contacting the UTS office and my tutor, failure to give the advanced notice will be considered a no call/no show.)
- OR  If I do not call/do not show for two (2) tutoring sessions, my tutoring privileges will be revoked for the remainder of
the semester.
My signature below indicates that I understand the mission, responsibilities, and expectations for tutees and agree to
meet these expectations. Should I have any further questions and/or require assistance, I will notify the office at x2720
or x5133.
___________________________________
Student Name (Printed)
___________________________________
Student Signature
Please Return To:
Bloomsburg University Tutorial Services
Student Services Center, Room 013
Bloomsburg University Bloomsburg, PA 17815
(570) 389-2720, sttutor@bloomu.edu
________________________
Date