Request edit access
Tutoring Referral Form
Tutoring takes place in the LPP office in room 502A. After school tutoring is only available only on Mondays, Tuesdays, and Thursdays.
* Required
Student's name (first and last)
*
Your answer
Name of staff member making referral
*
Your answer
Staff email address?
Your answer
I would like to offer extra credit to students who consistently attend tutoring for my subject.
*
Yes
No
N/A
What subjects are the reason for referral? Select all that apply.
*
Math
Science/Living Environment
English/ELA
History/Global
Other:
Required
What Regents does the student still need to complete? Select all that apply.
*
Math Regent
Living Environment
ELA
US History
Global
They have completed all regents requirements.
Unknown
Required
What days of the week is the student able to attend tutoring? Select all that apply.
*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Unknown
Required
What time of the day is the student typically able to attend tutoring?
*
Student would prefer lunch time tutoring (11:55 am - 12:55 pm)
Student would prefer after school tutoring (2:30 pm - 5 pm)
Student can attend tutoring both during lunch and after school.
Unknown
Required
What are the student's specific tutoring needs? Select all that apply.
*
Homework assistance
Reviewing class material
Assistance with a project
Studying for regents
Resume building/editing
College essay writing
Other:
Required
Additional questions, concerns, or important information regarding the student?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Harlem Renaissance High School.
Report Abuse
Forms
