Saint Martin's University - Learning Center - Peer tutors

Student Information/Tutoring Request Form

If you would like to get some tutoring help, please complete the tutoring request form below or download a copy. If you download a copy, the form can be printed, completed and turned in to a tutor or the Learning Center staff during regular business hours in Room 214. Forms are also available in the Learning Center during drop-in tutoring hours and from Learning Center staff during regular business hours.

Today's date:
Last name:
First name:
Address:
City:
State:
Zip:
Phone #:
Email:
Year:		FR SO JR SR Other
Major:
Date of birth:
Faculty advisor:
Campus:		Main Campus (Lacey) Fort Lewis McChord Centralia
How were you referred to the Learning and Writing Center?
		Advisor Other:
If on campus:
Residence hall:
Room:
Phone #:
Tutoring: Please indicate the course(s) for which you think you will need tutoring or peer reading services:
Course name:
Course number:

Course name:
Course number:

Course name:
Course number:

Completion of the following section is optional. The information provided will be used for statistical reporting and will not be used to determine eligibility for services.
Gender:
Veteran status:
Ethnic background:
		Other:
Please check any of the following that apply:
		First Generation College Student
		Student Athlete
		Academic Probation
		Student with Disability
		English as a second language (ESL)
		Limited English Proficiency (non ESL)
		Academic Honors (3.5 or above)