NHS Peer Tutor
Information Collection Form
This form is for students who are in need of a tutor for extra help in a subject they are struggling.
Please note that requests for tutors may be denied if the student has not previously met with their teacher for extra help during office hours at least once or twice a week. Tutoring sessions may be 30 minutes- 1 hour long depending on the arrangement made by the tutor and what works with their schedule.
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Grade Level
Please Select
09
10
11
12
Subject you need help in
Please Select
Math
Science
English
History
Foreign Language
Culinary
Music
Art
Business
Physical Education
Skills learning to improve through tutoring
Please Select
homework review
studying before a test
writing better
reading better
organization
concepts
strengthen understanding with extra practice
vocabulary
other
How often have you meet your teacher during office hours?
Please Select
once a week
twice a week
three times a week
four times a week
every day
I don't meet with them
Teacher's Name in the course you are struggling & specific course name (ex: Spanish II, Chemistry, Algebra
Teacher's Name
Specific Course Name
What is the best time for you to receive a tutoring session?
Please Select
Before school at 7- 7:30am
During lunch 12:40-1:20pm
After school 2:30- 3:30pm
Evenings 5-7pm
Do you prefer a bilingual student assisting you? If so, in what language?
*
No thanks, English is preferred.
Yes please, Spanish
Yes please, Polish
Other
Please list your study period above (example: Period 7)
Student Signature
Parent or Guidance Counselor Signature
Submit
Should be Empty: