Tutor Request Application

Name(first last):

Student ID# (no dashes):

Date (mmddyyyy):

E-mail address:

Phone (no dashes):

Hill College E-mail address:

*Most correspondence will be done through your Hill College email

I am requesting tutoring at:

I am requesting tutoring for:

I need tutoring in the following courses:

Best time for me to receive tutoring is:
Days: Times:

How often do you need tutoring:
Once a week Twice a week

Select "Yes" or "No" for each of the following statements
I qualified for the Pell Grant or other grant aid this semester:	Yes	No
At least one of my parents graduated from a four-year university:	Yes	No
I have a documented physical or learning disability on file with Hill College:	Yes	No
I am currently on Academic Probation:	Yes	No

Select the type of degree you are currently working towards:
	AA (Associate of Arts)
	AS (Associate of Science)
	AAS (Associate of Applied Science)
	CT (Certificate of Technology)
	CC (Certificate of Completion)
Please indicate your current major:

Select "Yes" or "No" for each of the following statements:
Are you an international student?	Yes	No
Are you a Veteran?	Yes	No

I have reviewed, understand and agree to the requirements, conditions and expectations regarding participation in the Tutoring Program at Hill College listed on the Tutoring Website.
Once the application is submitted, I understand that it could take 5-7 days before I am notified by a tutor or a tutor coordinator.