Student Success Centers
To be filled out by Student:
List the course that you are seeking to become a tutor. Complete this form and give it to the teacher that you had for the class listed below. If the instructor is no longer affiliated with CCRI or you are unable to contact the professor, please contact the chairperson of department that offers the class and have the chairperson complete the form.
The instructor or chairperson will return the form to the Student Success Center.
Name of Student: Student ID #:
|Course Name||Faculty Name||Grade Earned||Semester & Year Completed|
To be filled out by Faculty:
This student is interested in serving as a peer tutor for the Student Success Center for the course(s) listed above. The student has indicated that you served as the instructor for this course.
Please consider the following requirements for peer tutoring before you decide to recommend or not recommend the student to be a peer tutor for the course listed above.
Signature of Instructor: _____________________________________________________
Telephone: e-mail address:
Thank you for your support of Peer Tutoring offered through CCRI’s Student Success Centers