NURSING TUTOR REQUEST FORM
CONTACT INFORMATION
Name:
Date:
Regis Email:
Year of Grad:
Cell Phone:
Major:
COURSE INFORMATION: Please note your professor will be informed of your request for assistance and the peer tutor to which you
are assigned.
Course Title:
Course#:
Professor’s Name:
Estimated Avg:
Please enter below any information about you or difficulties you are having with the course that
might be helpful to the tutor in understanding how to best meet your tutoring needs.
List 4 time frames for tutoring that would accommodate your schedule. The broader you are the
easier it will be to match you to a tutor. (EX: M, W, F, 4pm – 7pm)
1.
2.
3.
4.
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For Ace To Complete
Tutor Matched With:
Date:
Notes: