Name First Last EMPLID SSSP Counselor Citymail Email Address Personal Email Address Course 1 Course Requested for Tutoring 1 Professor’s Name Frequency Frequency - Select -WeeklyBi-WeeklyCustom Custom Course 2 Course Requested for Tutoring 2 Professor’s Name Frequency Frequency - None -WeeklyBi-WeeklyCustom Custom Course 3 Professor’s Name Course Requested for Tutoring 3 Frequency Frequency - None -WeeklyBi-WeeklyCustom Custom When Are You Available? Date/Time Date/Time Date/Time Date/Time: Date Date/Time: Time Item weight Add more items more items Please note: each tutoring session begins on the half-hour and lasts for 50 minutes. On Fridays, the last tutoring session available is 2:30 PM. Custom Dates / Times Custom Request Student Status - None -FreshmanTransferContinuing Academic Class - None -FreshmanSophomoreJuniorSenior Cumulative GPA Are you a pre-med student? - Select -YesNo Are you a pre-law student? - Select -YesNo Career Goals Learning Style