enTECH@home Support Request Form

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All personal information collected from this form will not be sold, given, or used in any way other than to contact and support you.

What is your name? *

YYYY

Please provide your phone number or email address. *

When can we contact you?

Morning (9-12)

Afternoon (1-4)

Late afternoon (4-6)

Evening (6-9)

What do you need assistance with? Please give us as much detail as you can. *

Would you be interested in recurring tutoring sessions with a volunteer ( Biweekly or Weekly)? *

Yes

Is there a specific volunteer you would like to be paired with ( please provide a name ) ?

At the end of your session, if you are interested in working with the volunteer again, please let them know and we will ensure that they are your tutor for subsequent sessions.

I consent to be contacted in the future involving research to understand the impact of this program in the community *

I consent to being contacted.

I decline to be contacted

While we anticipate your time interacting with enTECH @Home will be positive, by clicking "I agree" you are confirming that the University of Waterloo, the Waterloo Undergraduate Student Association, the enTECH Computer Club, and/or its volunteers will NOT be held liable for any damages that may occur as a result of using the enTECH@home service. Additionally, you understand this service is being provided free of charge, and with no express or implied warranty. * *

I agree

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