Peer Tutor Course Selection Application Form
Last Name *
First Name *
Current Grade *
Number of days absent last semester *
Number of days late last semester *
Placement Preferences
In the next 3 responses, write the Subject and Teacher you would like to be placed with for Peer Tutoring, in order of choice, 1st, 2nd & 3rd.

Example: History Mr. Cook
Write the COURSE & TEACHER below that you would be your 1st choice to Peer Tutor. *
Write the COURSE & TEACHER below that you would be your 2nd choice to Peer Tutor. *
Write the COURSE & TEACHER below that you would be your 3rd choice to Peer Tutor. *
References
Provide the name of a teacher who would act as a reference for you.
(You should have had them as a classroom teacher)
Remember to ask their permission to be used as a reference.
This teacher will be contacted by Guidance for confirmation.

Example: Mr. Cook
Provide the name of a teacher who would act as a reference for you. *
Provide ANOTHER name of a teacher who would act as a 2nd reference for you. *
Submit
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This form was created inside of Durham District School Board.