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Last Name
*
First Name
Telephone
Mercer ID
*
Student Email
*
Last 4 digits of SSN
Classification
Freshman
Sophomore
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5th Year
Are you a current SSS Student
Yes (returning)
Yes (this is my first year in the program)
No
Course Name
Course Number
Day & Time the Class Meets
Professor's Name
Please explain the difficulties you are experiencing in the course above
Have you already contacted a SSS Counselor regarding your concerns?
Yes
No
If not, please follow up with a SSS counselor immediately after submitting this request.
Is tutoring offered in the ARC, SI sessions or through the Minority Mentor Program
Yes
No
Does the aforementioned offerings conflict with your class schedule?
If yes, please explain
Do you have a tutor in mind?
*
Yes
No
If so, please answer the questions about them, below.
Name
Contact Number
Email
Student ID Number
Classification
Freshman
Sophmore
Junior
Senior
Has this tutor-elect taken this course before?
Yes
No
What grade did they receive?
A
B
C
F
I
Is this student aware that you are requesting to hire them as a tutor?
Yes
No
Is this student work-study eligible?
Yes
No
I Don't Know
How many times would you like to meet with your tutor?
Once a week
Twice a week
Three+ times a week
When are you available for tutoring?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What times would you like to be tutored?
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