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Request a Peer Tutor

Personal Information
What is your ID number?
(This question is mandatory)
First Name:
(This question is mandatory)
Last Name:
(This question is mandatory)
Phone Number:
(This question is mandatory)
Email
(This question is mandatory)
Alternate Contact
(This question is mandatory)
The program I am enrolled in is
(This question is mandatory)
I give my permission to the Peer Tutor Coordinator to give my phone number(s) and/or e-mail to a tutor who has been hired to work with me.
(This question is mandatory)
I am requesting a tutor for the following class
(This question is mandatory)
Instructor's First Name
(This question is mandatory)
Instructor's Last Name
(This question is mandatory)
What city do you live in?
Available times for tutoring
Please list in each day the hours that you are available to tutor, for example, 9-11AM in the Monday box, 8-10AM and 4-6PM in the Wednesday box, etc. You may leave a day box empty if you are not available!
Days and Times Available
Comments about my schedule
(This question is mandatory)

I have read and understand the policies and procedures for the Peer Tutor program that is posted on the LTC Peer Tutor website and understand that the service may be withheld if I do not comply. 

Click here for the peer tutor agreement statement.