Tutor Name (First and Last):

Student/Empl ID # (7 digits) :

Question 1. Are you available to tutor this quarter?
      YES
      NO (please skip to Update Address Information below)

Question 2. What subject area(s) or specific class(es) are you confidently able to tutor this quarter? (e.g.: CHEM 102 or SPANISH- all courses)
Please list all that apply:


Question 3. What type of tutoring would you like to do? (please check all that apply)
      Drop-In Individual Learning Teams

Drop-in/Learning Teams:

Question 4. How many nights per week requested? 0 1 2 3

Question 5. What night(s) would you like to tutor? (please list)
Night(s) requested (1st choice):

Night(s) requested (2nd choice):

Night(s) requested (3rd choice):

Individual Tutoring:

Question 6. What days are you available for Individual Tutoring? (please check all that apply)

Day	Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Please help us update your information:

Address line 1: Apt / #:

Address line 2:

City: State: Zip:

Res.Hall /Apt phone number:

Cell phone number:

Other phone number:

NOTE: These numbers are for use by Tutoring Coordinators only; students will NOT receive your phone number to contact you for appointments unless you give it out yourself.

Email address you actively check:

Do you receive a monthly stipend?
      YES
      NO

Are you currently a TA for Northwestern University?
      YES
      NO
If so, which class(es) and professor(s) do you TA for: