Request Tutorial Services

Last Name*

First Name

Telephone

Mercer ID*

Student Email*

Last 4 digits of SSN

Are you a current SSS Student

Yes (returning)

Yes (this is my first year in the program)

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

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

Does the aforementioned offerings conflict with your class schedule?

If yes, please explain

Do you have a tutor in mind?*

Yes

If so, please answer the questions about them, below.

Name

Contact Number

Student ID Number

Classification

Has this tutor-elect taken this course before?

Yes

What grade did they receive?

Is this student aware that you are requesting to hire them as a tutor?

Yes

Is this student work-study eligible?

Yes

I Don't Know

How many times would you like to meet with your tutor?

When are you available for tutoring?

What times would you like to be tutored?

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