Chabot College
Learning Connection
Learning Assistant Request Form – for Fall 2016
To request Learning Assistant(s), please complete the following request form, save it, and return it as an
attachment to rtupper-eoff@chabotcollege.edu (You can also print this form and send it through campus mail
to the Learning Connection) NOTE: You must submit a SEPARATE request form for each course/CRN.
**REQUEST FORMS ARE DUE APRIL 15, 2016**
Instructor’s Name: ________________________________________________________
Instructor’s Email: ________________________________________________________
☐ I have already identified the student(s) with whom I want to work (see Learning
Assistants section below)
☐ I would like you to find potential Learning Assistants from the current pool of tutors
Class(es)
Course (ex. ENGL 102, MTH 65): ________________________ CRN: _____________
I would like to work with ______ Learning Assistant(s) for this class for ______ hours (each).
My Learning Assistant(s) will provide the following types of learning support (please check all that
apply):
☐ lab support
☐ lead discussion group(s) ☐ provide drop-in tutoring
☐ provide office-hour
☐ Other: _________________________
Learning Assistants
I am requesting the student(s) below as LA’s (please rank them in order of preference in case your top
choice(s) falls through):
Name: ___________________________ W#: _________________ # Hrs/wk: _______
Name: ___________________________ W#: _________________ # Hrs/wk: _______
Name: ___________________________ W#: _________________ # Hrs/wk: _______
Name: ___________________________ W#: _________________ # Hrs/wk: _______
☐ I have already spoken with these students to let them know the days and times I will
need them to work as LA’s next semester.
☐ I have informed these students that they will receive an invitation and application from
the Learning Connection, and that they will need to complete the application and
hiring process in order to be considered for a Learning Assistant position.
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What student learning goals do you hope to achieve by having a Learning Assistant in your class?
Briefly describe what the Learning Assistant will do in your class to support student learning and how
you plan to evaluate the program’s impact on the class.
Learning Assistant Program Information
Please read below and initial next to each to show that you understand the program policies and information:
1. I understand that the number of positions and hours that can be funded
differ per program and per semester.
2. I understand that any students I request as Learning Assistants must
complete the Learning Connection Scholar application and hiring
process.
3. I understand that Learning Assistants must be students enrolled
primarily at Chabot College, with a minimum enrollment of 3.0
academic units for the semester they would work as a Learning
Assistant.
4. I understand that Learning Assistants are tutors embedded into
classrooms/labs, and I agree to use my Learning Assistant to provide
direct support to students in this class. I will NOT use my Learning
Assistant to do paperwork (copying, filing, grading, attendance reports,
etc.).
5. I agree to attend an orientation session with the Coordinator, typically
yearly.
6. I agree to Allow Institutional Research to access data about my class(es)
in order to assess the overall effectiveness of the Learning Assistant
program. (The focus of this research is on the program, not on
individual classes or instructors. Instructors will not be named in any
publication of this research.)
7. I agree to participate in a campus-wide survey comparing courses that
have Learning Assistants to those that do not (administered every other
year).
8. I understand that Learning Assistant positions are offered per semester,
and that I will need to submit a new request for Learning Assistant(s)
every semester.
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Supervising Students
Students offered positions as Learning Assistants are hired as Student Assistant employees of CLPCCD. As
their LA Instructor, you will be responsible for supervising them and ensuring compliance with CLPCCD
labor policies as well as Learning Connection policies. Please initial next to each to show you understand
your supervisory responsibilities for your Learning Assistant(s):
1. I understand that LA’s are responsible for recording the hours they work
each week on a time card, and that I will sign the time card to verify their
hours at the end of the week.
2. I understand that student assistants are entitled to a paid fifteen (15)
minute break every four (4) hours of consecutive work at approximately
the halfway point, which I will provide as needed.
3. I understand that student assistants must take uninterrupted unpaid lunch
for at least thirty (30) minutes when working six (6) or more consecutive
hours in one (1) day. If my LA is also working as a tutor, I will
coordinate the schedule(s) with LC staff.
4. I understand that student assistants cannot work more than eight (8)
hours per day or more than twenty (20) hours per week between any/all
on-campus jobs they may be working, and that student assistants cannot
work on any days when the campus is closed due to holidays or other
campus closures.
5. I understand that all learning support provided by my Learning Assistant
must be supervised by me as the designated supervisor/instructor.
**Please note, Learning Assistant Requests are dependent upon funding. We will notify you of the
status of your request once we receive our budget.**
Thank you for participating in Chabot College’s Learning Assistant program! Learn more about
this and other Learning Connection programs at our website:
www.chabotcollege.edu/learningconnection
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