Rx Care Form

Today's Date

Date*

First and Last Name

Name*

Student ID Number

ID Number*

Email Address

Email

Local Address

Local Address

Permanent Address

Permanent Address

Phone Number

Phone Number

Request for tutoring in the following course(s). List Course Name and Professor:

1. Course Name

1. Professor

2. Course Name

2. Professor

3. Course Name

3. Professor

Describe the difficulty you are having with the course(s):

You may choose more than one from the drop-down menu.*

Other (please specify)

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.