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NHS Peer Tutor Request Form
Data entered in the form below will be used by the National Honor Society Tutoring Chairs to match Longmeadow Public School students with peer tutors during the time you indicated below. Please provide all of the requested information to ensure the best possible match. If you are requesting a peer tutor for more than one course, please enter the names of
both
courses on the line entitled "Course Title" NHS tutoring taking place in person will not have transportation provided.
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* Indicates required question
Email
*
Your email
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Grade Level
*
For example: 6th, 9th, 10th, etc.
Your answer
Student's school they are attending
*
Longmeadow High School
Glenbrook Middle School
Williams Middle School
Blueberry Hill Elementry School
Center Elementry School
Wolf Swamp Elementry School
Other:
Student's email
*
Your answer
Parent(s)/Guardian name
*
Your answer
Emergency Contact Information
*
Please list a friend or family member (including email and phone #) that we can contact in case the parent/Guardian listed above can not be reached
Your answer
Course Title
*
Enter the name(s) of the course(s) for which you are requesting a peer tutor.
For example: Algebra 2 Honors, CP1 English 3, AP Biology, 7th Grade Math, etc.
Your answer
Teacher's Name
*
Please enter the name(s) of the instructor(s) for the course(s) listed above.
For example: Mrs. Baker (math), Mr. Staples (English), etc.
Your answer
What platform/location does the student prefer?
*
Please remember that transportation is not available for in-person tutoring.
Storrs Library
ICE Blocks (LHS students only)
Zoom (or other online platform)
No preference
Other:
Required
Is there any other information about your student that you would like us to know about?
Please include a high school student's ICE blocks if you would like ICE Block tutoring.
For example: A1, D6, G8, etc.
Your answer
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