Xavier University - Learning Assistance Center

Student Information

Name *

Student ID *

The ID number on your ALLCard that begins with "000"

E-Mail Address *

Phone Number *

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Have you previously requested tutoring services through the LAC? *

May we notify your professor about your tutoring? *

Who were you referred by?

Course Information

#1 Course Name and Number *

#1 Professor *

#1 Current or Midterm Grade *

#1 Need Assistance With *

#1 How often would you like to be tutored? *

#1 How long would you like your sessions to be scheduled? *

#2 Course Name and Number

#2 Professor

#2 Current or Midterm Grade

#2 Need Assistance With

#2 How often would you like to be tutored?

#2 How long would you like your sessions to be scheduled?

#3 Course Name and Number

#3 Professor

#3 Current or Midterm Grade

#3 Need Assistance With

#3 How often would you like to be tutored?

How long would you like your sessions to be scheduled?

If you are requesting a tutor for General Biology, General Chemistry, Organic Chemistry, or Anatomy & Physiology, you are strongly encouraged to attend the SI sessions for your course. A tutor may be assigned after you have regularly attended SI sessions.
At times, there can be a waitlist for tutoring services and working with another student may help minimize the time you are on the waitlist. Therefore, you may be paired with another student in the same course.

Tutoring Environment

I cannot work with any distractions (noise or people moving about occasionally talking quietly.)
I cannot work in complete silence.
I cannot work without lots of natural light.
I cannot work in a bright room.
I am flexible, I can concentrate fairly well in most light and noise environments.
I don’t know.

Tutoring Availability

Starting with tomorrow, please list the time slots that you are available for tutoring. Give as much availability as possible.

If today is Wednesday, fill out Thursday, Friday, etc. for when you’re available tomorrow and the days after. Complete Monday through Wednesday for when you are available next week.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Barsch Learning Style Inventory Results

Visual

Auditory

Tactile

Kinesthetic

Tutoring Agreement

<p> I agree to come to my tutoring sessions prepared with books, notes, syllabus, and other class materials. I also agree to be prompt to my appointments, and will contact my tutor at least 24 hours in advance if I cannot make a scheduled appointment. I understand that I will be notified if there are any concerns about my attendance. The LAC staff has my permission to access my grades for records, and these grades will be kept confidential.</p>

* I agree