Student's Last Name: ____________________
Grade & Homeroom: __________
Date of Application: ____________________
Email: _______________________________
Medical Problems? (YES) (NO)
If so, please specify:__________________________________________________
Mathematics Section
Grade (Specify subject for Gr.11 and up): _________________________________
Teacher: ____________________
Specify problems/areas of concern:
___________________________________________________________________
Provide the time(s) and day(s) of the week that you would like to have your peer tutoring session (Note: The availability is Mon. to Fri. at either lunch, 3:15 to 4:15 or in the morning)
___________________________________________________________________
General Subjects
Grade & Subject: ________________________
Teacher:_______________________________
Specify problems:
__________________________________________________________________
Provide the time(s) and day(s) of the week that you would like to have your session.
___________________________________________________________________