Learning Services Peer Tutor Request Form

Please complete the form below in order to request a Peer Tutor. You should complete one form for EACH course in which you would like a tutor; do not try to combine multiple courses into one form.

After you complete the form, you will receive an e-mail confirmation of submission, and you should receive additional information about your assigned Peer Tutor within about a week. We appreciate your patience. If there are any issues with your request, you will be contacted.

Any questions about Peer Tutoring should be directed to Kristin Sites, Associate Director of Learning & Success, at sites@msmary.edu or at 301-447-5133.

Date of Application*

MonthDayYear

Name*

First NameLast Name

Class Standing*

Enter your class level

Cell or Local Phone Number*

Phone Number

May we contact you via text message? *

YesNo

Mount Email Address*

example@email.msmary.edu

Course Number/Section:*

Example: SPAN 101 A

Instructor Name:*

Preferred frequency of tutoring: *

Preferred frequency of tutoring*

Please briefly explain your course needs/ concerns for tutoring:*

Please choose your preference for the method of tutoring (note: we will do our best to honor preferences, but the method of tutoring may vary or change depending upon the circumstances).*

In-Person TutoringBlended (Some In-Person, Some Video)Video TutoringAny Method/No Preference

Would you be interested in small group tutoring? (If available for your course)*

YesNo

Other Requests/Preferences (i.e. scheduling preferences, practice/rehearsal times, other specific requests):

Tutoring Contract Agreement

I have read the tutoring contract agreement linked above.*

Yes