Rx Care Form



Today's Date
First and Last Name 
Student ID Number
Email Address
Local Address
Permanent Address
Phone Number 
Request for tutoring in the following course(s). List Course Name and Professor:
Describe the difficulty you are having with the course(s):
Individual Tutoring Agreement

  • I will attend tutoring sessions as scheduled. 
  • If I cannot meet with my tutor, I will cancel a minimum of 24 hours in advance. 
  • I understand that if I miss two sessions without canceling 24 hours in advance, I will not be able to schedule individual tutoring for the remainder of the month. 
  • I understand that if I am over 15 minutes late, I am considered a "no show.
  • I agree to complete evaluations of tutoring sessions as requested. 
  • I will come to tutoring sessions prepared with specific questions.
  • I will bring my text and all pertinent materials.
  • I understand my tutor will not do my work for me. 
By pressing "SUBMIT," it is implied that I have read and understood the CARE policy and procedure.